Background/Objectives: This study compares clinical and radiological outcomes of open microscopic posterior cervical foraminotomy (PCF) and biportal endoscopic spine surgery (BESS) PCF in multi-level cases. While BESS PCF is effective in single-level surgeries, its role in multi-level procedures remains unclear. Methods: This retrospective cohort study included 60 patients treated for cervical radiculopathy from 2016 to 2023, divided into two groups, open microscopic PCF (Group M, n = 30) and BESS PCF (Group B, n = 30). Clinical outcomes were assessed using visual analogue scale (VAS) scores for neck and arm pain and the neck disability index (NDI). Radiological parameters included cervical angle, segmental angle, range of motion (ROM), and the extent of facetectomy. Results: Both groups showed improvement in the arm pain VAS and the NDI. However, Group B exhibited significantly better neck pain on the VAS at the final follow-up (p = 0.03). Radiologically, Group B maintained lordotic cervical and segmental angles postoperatively, while Group M showed kyphotic changes (p < 0.01). Segmental ROM was larger in Group M, indicating greater instability (p < 0.01). Group B had less extensive facetectomy while achieving comparable foraminal enlargement. Operative time was longer for Group B (p < 0.001). Conclusions: BESS PCF preserves cervical stability and reduces postoperative neck pain compared to open microscopic PCF in multi-level procedures. Despite longer operative times, its benefits in minimizing instability make it a promising option for treating multi-level cervical radiculopathy. Further research with long-term follow-up is recommended.

Background/Objectives: Distal adding-on (DA) is a common postoperative phenomenon in Lenke type 2A adolescent idiopathic scoliosis (AIS). Postoperative shoulder imbalance (PSI) is a clinically significant issue following AIS correction, as it may lead to aesthetic dissatisfaction, functional impairment, and reduced quality of life. This study investigated radiographic changes in DA and shoulder balance in Lenke type 2A AIS, particularly focusing on distal wedge angle (DWA) and radiologic shoulder height (RSH) in patients with right sacral slanting (RSS). Methods: We retrospectively analyzed 120 patients with Lenke type 2A AIS who underwent posterior spinal fusion. Patients were grouped by sacral slanting: right (RSS), left (LSS), or none (NS). Radiographic parameters including proximal thoracic curve angle, main thoracic curve angle, DWA, RSH were assessed at multiple time points. Univariate and multivariate linear regression analyses were used to identify factors associated with DA. Results: The RSS group consistently showed the highest DWA and the greatest incidence of DA. RSH initially exceeded the PSI threshold in all groups but decreased to approximately 10 mm by final follow-up. In the RSS group, the inverse relationship between increasing DWA and decreasing RSH was most pronounced. Univariate regression identified postoperative RSH and sacral slanting angle as significant predictors of DWA, though not in the final multivariate model. Conclusions: In Lenke type 2A AIS with RSS, an increasing DWA and decreasing RSH over time suggest that DA may serve as a compensatory mechanism for PSI. Sacral slanting and postoperative RSH may be relevant predictors of this dynamic alignment change.

Background and Objectives: Posterior cervical foraminotomy (PCF) aims to resolve cervical radiculopathy while preserving range of motion (ROM). However, its effectiveness in maintaining ROM is uncertain. This study investigates the changes in ROM after PCF and identifies preoperative factors that influence ROM reduction post surgery. Materials and Methods: This retrospective cohort study included patients treated at our hospital from August 2016 to September 2021. Clinical outcomes were assessed using the visual analog scale (VAS) for neck and arm pain and the neck disability index (NDI). Radiological outcomes included the segmental angle (SA), cervical angle (CA), C2–C7 SVA, Pfirrmann grade, extent of facetectomy, foraminal stenosis, and ROM. Patients were categorized into two groups based on segmental ROM changes: decreased (Group D) and maintained (Group M). Radiological and clinical outcomes were compared between the groups. Univariate and multivariate regression analyses were performed to identify risk factors for ROM loss after PCF. Results: 76 patients were included: 34 in Group D and 42 in Group M, with no demographic differences. Preoperatively, Group D had significantly larger flexion segmental and cervical angles than Group M (segmental, p < 0.001; cervical, p = 0.001). Group D also had a higher Pfirrmann grade (p = 0.014) and more bony bridge formations (p = 0.004). While no significant differences were observed in arm pain VAS and NDI scores, Group D exhibited worse neck pain VAS at the last follow-up (p = 0.03). Univariate linear regression indicated that preoperative segmental ROM (p < 0.001, B = 0.82) and bony bridge formation (p = 0.046, B = 5.33) were significant predictors of ROM loss post PCF. Conclusions: Patients with higher preoperative flexion angles and Pfirrmann grades at the operative level are at an increased risk for ROM loss and neck pain and often exhibit bony bridge formation. Accounting for these factors can improve surgical planning and patient outcomes.

Background/Objectives: Thoracolumbar burst fractures often require surgical stabilization. Although posterolateral fusion (PLF) has been traditionally used, percutaneous posterior fixation (PPF) without fusion has emerged as a less invasive alternative. However, comparative data specifically addressing PPF and PLF are limited. This study aimed to compare the radiological and perioperative outcomes of PPF and PLF for thoracolumbar burst fractures. Methods: This retrospective cohort study analyzed 61 patients with T11–L2 burst fractures (PPF, 28; PLF, 33). Radiological parameters included local and global sagittal alignment and vertebral height ratio. Fracture morphology was assessed using a structured grading system based on anterior height ratios. Perioperative variables were also assessed. Statistical significance was set at p < 0.05. Results: PPF demonstrated significant advantages in operative time (160.7 min vs. 205.8 min, p < 0.01) and blood loss (165 cc vs. 317 cc, p < 0.01), with a shorter hospitalization time. PPF achieved outcomes comparable to PLF in global alignment and anterior height restoration. The PLF group showed greater local kyphotic angle correction (−7.77° vs. −1.53°, p = 0.01), whereas the PPF group showed significantly higher postoperative posterior height ratio (p = 0.02). Changes in morphological grades, assessed using the anterior height ratio-based grading system, showed similar patterns of improvement in both groups. All implant removals were performed due to patient-reported discomfort. Conclusions: PPF yielded radiological outcomes comparable to PLF in the treatment of thoracolumbar burst fractures. The use of a morphological grading system provided a structured descriptive tool to evaluate surgical impact, though its utility remains exploratory and requires further validation.