Jehovah's Witness (JW) is an evangelical Christian denomination best known to physicians for beliefs regarding the refusal of all blood product transfusions. This chapter presents a case study of a 54-year-old female with a history of obstructive sleep apnea, hyperlipidemia, and scoliosis who presented for T10-L5 posterior spinal fusion. The arterial blood gas analysis was used not only to assess respiratory and metabolic state but also the hematocrit. The antifibrinolytic drug aminocaproic acid was infused during the case to reduce blood loss. Erythropoietin is a blood-stimulating hormone normally synthesized in the kidney that stimulates red blood cell production in the bone marrow. While complex spine procedures in the JW patient may be challenging, successful outcomes can be achieved. With active preoperative assessment, communication, blood conservation strategies, proper positioning and meticulous surgical and anesthetic technique, complex spine surgeries are possible in the JW population.