Three-Column Osteotomies: Past, Present, and Future

Three-Column Osteotomies (3CO's) refer to osteotomies that involve surgical removal of parts or all of the posterior, middle and anterior columns of the spine. The indications for using a 3CO in the surgical treatment of Adult Spinal Deformity (ASD) have slowly evolved over time but remains idiosyncratic for surgeons treating complex ASD patients. This manuscript will focus on the past and present use of 3CO's to highlight the changes over time in the indications, techniques, surgical results, complications and outcomes to place these procedures in the proper context to then discuss their probable use among ASD patients in the future.