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Pediatric neuromuscular spinal deformity surgeries are complex due to the multisystem involvement of the diseases commonly encountered. Complication rates may exceed 25%, in a stark contrast to adolescent idiopathic scoliosis. A multidisciplinary approach is mandatory to minimize the risk of complication. Furthermore, the perioperative team should be well versed in the care of these complex patients. Malnutrition is not uncommon and nutrition should be optimized before surgery, as these are generally elective and not performed on an emergent basis. Some comorbidities are “fixed” and not modifiable, such as cardiomyopathy or seizure disorders. Thus, knowledge of perioperative management of these comorbid conditions is required to avoid potentially common pitfalls. The physical examination helps define patient needs and assists with surgical planning, including patient positioning, which may not be …