Background: Thoracolumbar burst fractures are a common traumatic vertebral fracture in the spine, and pedicle screw fixation has been widely performed as a safe and effective procedure. However, after the stabilization of the thoracolumbar burst fractures, whether or not to remove the pedicle screw implant remains controversial. This review aimed to assess the benefits and risks of pedicle screw instrument removal after fixation of thoracolumbar burst fractures. Methods: Data sources, including PubMed, EMBASE, Cochrane Library, Web of Science, Google Scholar, and Clinical trials.gov, were comprehensively searched. All types of human studies that reported the benefits and risks of implant removal after thoracolumbar burst fractures, were selected for inclusion. Clinical outcomes after implant removal were collected for further evaluation. Results: A total of 4051 papers were retrieved, of which 35 studies were eligible for inclusion in the review, including four case reports, four case series, and 27 observational studies. The possible risks of pedicle screw removal after fixation of thoracolumbar burst fractures include the progression of the kyphotic deformity and surgical complications (e.g., surgical site infection, neurovascular injury, worsening pain, revision surgery), while the potential benefits of pedicle screw removal mainly include improved segmental range of motion and alleviated pain and disability. Therefore, the potential benefits and possible risks should be weighed to support patient-specific clinical decision-making about the removal of pedicle screws after the successful fusion of thoracolumbar burst fractures. Conclusions: There was conflicting evidence regarding the benefits and harms of implant removal after successful fixation of thoracolumbar burst fractures, and the current literature does not support the general recommendation for removal of the pedicle screw instruments, which may expose the patients to unnecessary complications and costs. Both surgeons and patients should be aware of the indications and have appropriate expectations of the benefits and risks of implant removal. The decision to remove the implant or not should be made individually and cautiously by the surgeon in consultation with the patient. Further studies are warranted to clarify this issue. Level of evidence: level 1.

To compare radiographic parameters between sciatic scoliosis (SS) and Lenke 5/6 idiopathic scoliosis (IS) in young patients and to develop a predictive model. A total of 148 patients (SS: IS = 75:73) were retrospectively enrolled. Demographic data and preoperative radiographic parameters were recorded. Univariate analysis was conducted between the two groups. Least Absolute Shrinkage and Selection Operator (LASSO) regression and logistic regression were used to screen for risk factors, and a nomogram designed to differentiate the two types of scoliosis was further constructed. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA), with bootstrap resampling (1000 iterations). Compared with the IS group, the SS group was found to have a smaller lumbar lordosis (LL) and vertebral rotation, but larger pelvic tilt (PT) and coronal trunk shift (all p < 0.05). LASSO regression retained five variables, while logistic regression identified body mass index (BMI), LL, and mean vertebrae rotation (MVR) as independent predictors. The nomogram based on these predictors achieved an AUC of 0.957 (95% CI: 0.930-0.983) and showed good calibration (mean absolute error = 0.019). BMI, LL, and MVR are accurate, reliable predictors for distinguishing SS from Lenke 5/6 IS in young patients, providing a diagnostic basis for clinical practice.

Study Design: Retrospective study. Objective: To evaluate the long-term clinical and radiographic outcomes of SLAC for multilevel DCM and to determine whether outcomes differ between patients with cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL). Methods: A total of 146 patients were reviewed, including 99 patients with CSM and 47 with OPLL. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) score, JOA recovery rate, Neck Disability Index (NDI), modified MacNab, bone fusion rate and postoperative complications. Radiographic parameters included C2-C7 Cobb angle and cervical range of motion (ROM). The mean follow-up was 156.5 ± 23.2 months. Results: Both groups showed significant postoperative improvement in JOA and NDI scores. In the CSM group, the JOA score improved from 11.4 ± 2.8 preoperatively to 15.0 ± 1.8 at the best postoperative follow-up and remained 14.1 ± 2.5 at final follow-up. In the OPLL group, the JOA score improved from 11.0 ± 3.4 to 14.7 ± 2.2 and remained 14.0 ± 2.0 at final follow-up. No significant intergroup differences were observed in JOA score, NDI, modified MacNab grade distribution, or postoperative complications. However, both groups showed a mild but significant decline in neurological function from the best postoperative status to final follow-up. Radiographically, cervical lordosis decreased significantly only in the CSM group. Preoperative ROM was smaller in the OPLL group, and ROM decreased significantly in both groups. Conclusion: SLAC provides durable decompression and sustained functional improvement for multilevel DCM, with comparable long-term outcomes between CSM and OPLL patients.

Study Design: A retrospective study. Objective: To investigate whether the preoperative classification and changes in the intramedullary increased signal intensity (ISI) on axial T2-weighted magnetic resonance imaging (MRI) reflect the postoperative functional outcome in patients after laminoplasty for cervical spondylotic myelopathy (CSM). Summary of Background Data: Although patients with CSM exhibit ISI on axial MRI, the association between ISI (preoperative classification and changes) and surgical outcomes has not been investigated. Patients and Methods: We retrospectively included patients with CSM who underwent MRI preoperatively and at least 10 years postoperatively after laminoplasty between January 2009 and December 2010. According to axial images for the cervical compressive myelopathy (Ax-CCM) system, the ISI on axial images was classified as follows: type 0, normal; type 1, diffuse; type 2, fuzzy focal; and type 3, discrete focal. Functional outcomes, as measured by the Japanese Orthopaedic Association (JOA) score and JOA recovery rate, were evaluated based on the Ax-CCM classification. Results: Forty-three patients were enrolled. The mean follow-up time was 11.0±1.0 years. At the final follow-up, postoperative changes in the type of ISI were observed in 62.8% of patients. The type of ISI improved in 5 patients (11.6%), remained unchanged in 16 patients (37.2%), and worsened in 22 patients (51.2%). Patients with preoperative type 2 ISI had worse postoperative JOA scores and JOA recovery rates than those with other types. A worse ISI type was related to a lower postoperative JOA score and a lower recovery rate at the final follow-up. Conclusions: Type 2 ISI was associated with poor postoperative symptoms and low postoperative function improvement. ISI changed after laminoplasty in 27 patients (62.8%), and worsened ISI was related to poor surgical outcomes.