The Necessity of Implant Removal after Fixation of Thoracolumbar Burst Fractures-A Systematic Review

Xing Wang; Xiang-Dong Wu; Yanbin Zhang; Zhenglin Zhu; Jile Jiang; Guanqing Li; Jiacheng Liu; Jiashen Shao; Yuqing Sun

doi:10.3390/jcm12062213

The Necessity of Implant Removal after Fixation of Thoracolumbar Burst Fractures-A Systematic Review

J Clin Med. 2023 Mar 13;12(6):2213. doi: 10.3390/jcm12062213.

Authors

Xing Wang¹, Xiang-Dong Wu², Yanbin Zhang³, Zhenglin Zhu⁴, Jile Jiang³, Guanqing Li³, Jiacheng Liu⁴, Jiashen Shao⁵, Yuqing Sun³

Affiliations

¹ Department of Spinal Surgery, Shihezi General Hospital of the Eighth Division, Shihezi 832002, China.
² Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing 100035, China.
³ Department of Spine Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing 100035, China.
⁴ Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
⁵ Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.

Abstract

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.

Keywords: complications; implant; kyphosis; pain; pedicle screw; removal; thoracolumbar burst fracture.

Publication types

Review

Grants and funding

This study was supported by the Beijing Jishuitan Hospital Natural Fund Incubation Program (Grant No. ZR-202304), Beijing Municipal Science & Technology Commission (Grant No. Z191100004419007), and Beijing Jishuitan Hospital Research Funding (Grant No. XKGG201811).