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The Load-Sharing Classification is a straightforward way to describe the amount of bony comminution in a spinal fracture. When applied to patients with isolated spine fractures who are cooperative with 3 to 4 months of spinal bracing, it can help the surgeon select short-segment pedicle-screw-based fixation using the posterior approach for less comminuted injuries and the anterior approach for those more comminuted. The choice of which fracture-dislocations should be strut grafted anteriorly and which need only posterior short-segment pedicle-screw-based instrumentation also can be made using the Load-Sharing Classification.

The incidence of PJF among surgically treated patients with ASD was 1.4%. The most common type of PJF was 2N. Preoperative large sagittal vertical axis change and large amount of correction was a causative factor for spondylolisthesis above the UIV. After the revision surgery, further PJF was a commonly occurred event.

Axial computed tomography is necessary for the preoperative planning. Because of the small diameter and steep angulation of cervical pedicles, every spine surgeon who intends to use pedicle screws should first master the technique on cadavers.