Is Removal of Implants Mandatory Following Minimally Invasive Percutaneous Screw-Rod Stabilization Without Fusion for Mono-Segmental Thoracolumbar Fractures in Elderly Patients?

Abstract

Purpose: Despite the lack of evidence, the current standard of care following posterior pedicle screw-rod stabilization for spinal trauma includes instrumentation removal. This retrospective cohort study aimed to assess the necessity of implant removal in patients aged ≥65 years who underwent minimally invasive pedicle screw-rod fixation for AO type A and B thoracolumbar fractures.

Methods: We evaluated the clinical and radiological outcomes of 57 patients aged ≥65 years with mono-segmental AO type A and B thoracolumbar fractures treated with percutaneous short-segment pedicle screw fixation, and compared the two groups with and without hardware removal. Clinical outcomes included the visual analog scale score for back pain (VAS), Oswestry Disability Index (ODI), residual chronic back pain (RCBP) and implant-related complications. Radiological parameters, such as the vertebral wedge angle (VWA), segmental kyphosis Cobb angle (SKCA), anterior edge height ratio (AEHR) and adjacent intervertebral height index (IHI), were measured.

Results: No significant differences were observed between the two groups in the mean VAS and ODI values at 12 months and final follow-up. The incidence of RCBP in the implant retention group (25.9%) was slightly higher than that in the implant removal group (20%). However, there were no significant differences between the two groups. Both groups showed correction loss over time. An increase in the segmental kyphosis Cobb angle only differed by 2.02° with no significant difference between the two groups at final follow-up (implant removal group A 4.15°, implant removal group 2.13°). However, whether the implant was removed or not, no statistically significant differences were found in the correction loss of SKCA, VWA, IHI, or AEHR between the two groups within the 12-month follow-up period.

Conclusion: Our results suggest that percutaneous short-segment pedicle screw fixation showed similar radiological and functional outcomes in patients aged ≥65 years, regardless of whether the implants were removed after fracture healing.