Thoracolumbar deformity cases have always been the kind of operations that test a surgeon’s willpower, anatomy knowledge, and — when performed in the ambulatory surgery center — the limits of fluoroscopy.
When you’re placing screws around a rotated pedicle the size of a pencil eraser, with the aorta and spinal cord competing for “most important structure not to violate,” accuracy isn’t a luxury; it’s the difference between a good day and a morbidity report.
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