Gibb R, Ercoline B, Scharff L. Spatial disorientation: decades of pilot fatalities. Aviat Space Environ Med 2011; 82:717-24.Spatial disorientation (SD) has been a contributing factor in aviation mishaps for decades and efforts to mitigate SD have not been proportionate to the danger it poses to pilots. We argue that SD contributes to nearly 33% of all mishaps with a fatality rate of almost 100%. However, SD has not garnered the respect and awareness it requires from leadership and pilots because of historically inaccurate reporting within accident investigations and under-reporting of SD data in research. Over 30 research studies and 10 mishap case studies are presented to portray SD's role in aviation accidents since 1913. Research and training are recommended to improve pilot respect and awareness for SD-inducing scenarios that would include pilot recognition and successful recovery using SD-specific simulators. Consequently, funding is needed to further SD research, to fund SD training, as well as amend the current mishap investigation process to better articulate SD contributions in aviation accidents.