There are few moments in spine surgery that feel as heroic — and as humbling — as committing to a three-column osteotomy (3CO). It’s the spinal equivalent of saying, “Yes, I will realign the universe today.” And then quietly wondering what the nerves are going to think about it.
A prospective, multicenter effort from the International Spine Study Group set out to answer the question many have asked in the OR, usually around hour six: What is the true neurologic cost of a 3CO compared with adult deformity cases that don’t require one?
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