Innovations in spine surgery date back to the late nineteenth century when sterile surgery and anesthesia made progress possible. Were these advancements always done within the framework of ethical behavior, or were patients placed at inappropriate risks just for the sake of change? How does a surgeon choose to do a new procedure? What inner questions must be asked before proceeding? How much training is necessary, and from whom? How do we know when a new innovation is valid? In reality, these and other questions have faced us in the past. A review of historical process gives answers as to how we should behave in the future.