Instrumentation Removal following Minimally Invasive Posterior Percutaneous Pedicle Screw-Rod Stabilization (PercStab) of Thoracolumbar Fractures Is Not Always Required

Abstract

Study Design. Clinical case series. Background. Percutaneous stabilization for spinal trauma confers less blood loss, reduces postoperative pain, and is less invasive than open stabilization and fusion. The current standard of care includes instrumentation removal. Objective. 1. Reporting patient outcomes following minimally invasive posterior percutaneous pedicle screw-rod stabilization (PercStab). 2. Evaluating the results of instrumentation retention. Methods. A prospective observational study of 32 consecutive patients receiving PercStab without direct decompression or fusion. Baseline data demographics were collected. Operative outcomes of interest were operative room (OR) time, blood loss, and length of hospital stay. Follow-up variables of interest included patient satisfaction, Numeric Rating Scales for Back and Leg (NRS-B/L) pain, Oswestry Disability Index (ODI), and return to work. Clinical outcome data (ODI and NRS-B/L) were collected at 3, 12, 24 months and continued at a 24-month interval up to a maximum of 8 years postoperatively. Results. 81.25% of patients (n = 26) retained their instrumentation and reported minimal disability, mild pain, and satisfaction with their surgery and returned to work (mean = 6 months). Six patients required instrumentation removal due to prominence of the instrumentation or screw loosening, causing discomfort/pain. Instrumentation removal patients reported moderate back and leg pain until removal occurred; after removal, they reported minimal disability and mild pain. Neither instrumentation removal nor retention resulted in complications or further surgical intervention. Conclusions. PercStab without instrumentation removal provided high patient satisfaction, mild pain, and minimal disability and relieved the patient from the burden of finances and resources allocation of a second surgery.

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

“…The full texts of the remaining 69 articles were retrieved for further assessment. Finally, 35 studies were included in the systematic review [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ]. Figure 1 displays a flow diagram that shows the reasons for exclusion at each stage of the selection process.…”

“…In total, four case reports [ 30 , 31 , 32 , 33 ], four case series [ 34 , 35 , 36 , 37 ], 21 retrospective cohort studies [ 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 48 , 49 , 52 , 53 , 55 , 56 , 57 , 58 , 60 , 61 , 63 , 64 ], three retrospective case-control studies [ 46 , 51 , 62 ], and three prospective cohort studies [ 50 , 54 , 59 ] were included in this systematic review. These studies were published between 1997 and 2022 [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , …”

“…These studies were published between 1997 and 2022 [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ]. Among the included studies, 25 were from Asia [ 33 , 34 , 35 , 36 , 39 , 40 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 52 , 54 , 55 , 56 , 60 , 61 , 63 , 64 ...…”

“…Among the included studies, 25 were from Asia [ 33 , 34 , 35 , 36 , 39 , 40 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 52 , 54 , 55 , 56 , 60 , 61 , 63 , 64 ], six were from Europe [ 31 , 32 , 37 , 41 , 51 , 53 ], and four from North America [ 30 , 38 , 59 , 62 ]. Except for Xu et al [ 64 ], which included patients aged over 65 years, other trials were of adult patients [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ,…”

“…Of the 27 observational studies, nine [ 39 , 41 , 44 , 46 , 49 , 53 , 56 , 59 , 63 ] reported significant pain relief after implant removal; of these, four studies [ 39 , 41 , 44 , 59 ] reported the decision to remove the pedicle screw instrument due to implant-associated symptoms such as pain or discomfort, while in three studies [ 46 , 53 , 59 ] the patients were asymptomatic before implant removal. One retrospective cohort study [ 47 ] found that 10 of 27 patients had increasing back pain after implant removal, while in another retrospective cohort study [ 60 ], 12 of 21 patients reported reduced back pain or discomfort after surgery.…”