Proper recognition and management of apical prolapse is imperative in maximizing surgical outcomes in women with multi-compartment pelvic organ prolapse. Sacrospinous ligament fixation is a safe and effective, transvaginal and extraperitoneal procedure for apical prolapse. However, the sacrospinous ligament is an anatomically vulnerable location, which lends technical complexity to the procedure along with the risk of rare but important complications. This chapter will serve as a guide for the recognition and management of complications of sacrospinous ligament fixation.