Undetected severe complication after elective lumbar surgery - How could it happen?

•Neurosurgery remains among the highest malpractice risk specialties in medicine.•Lumbar discectomy leads rarely to life-threatening complications, like arteriovenous fistula.•Even manifest complications may remain undetected because of unsafe processes in the system.•Communication with all providers who are involved with the patient is critical to support patient safety.•The legal response to accidents in healthcare should help to promote safer practice.