Does the Removal of Spinal Implants Reduce Back Pain?

Ak, Hakan; Gülşen, İsmail; Atalay, Tugay; Muzaffer, Gencer

doi:10.14740/jocmr2141w

Cited by 9 publications

(11 citation statements)

References 10 publications

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“…After removing their implants, the mean visual analog scale score was decreased from 8.08 to 3.36 points, but ve (20%) patients (including all four recurrent LDH cases) did not report a reduction in pain. Meanwhile, no patient reported complete relief from pain (10) in an investigation of 57 patients who underwent implant removal after fusion and xation because of pain and discomfort; the initial diagnoses in this study were fracture (40%) and degenerative spine disease (58%). In a survey conducted from six to 24 months after surgery, 36 (61%) patients stated that they had experienced some bene ts of the operation, but only seven (12%) of them felt preoperative discomfort had been restored completely; moreover, 36 (63%) patients would undergo the operation again (6).…”

Section: Discussionmentioning

confidence: 60%

“…In practice, whether internal xations located at intervertebral fused segments should be removed has not garnered a consensus among clinicians (9,10) due to a lack of evidence-based clinical investigations. In the present study, we proposed that the removal of internal xations (transpedicular screws and rods, which are inserted into the vertebral pedicle to provide xation) after successful intervertebral fusion would not affect patients' quality of life.…”

Section: Introductionmentioning

confidence: 99%

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Is Removal of the Internal Fixation After Successful Intervertebral Fusion Necessary? A Case–control Study Based on Patient-reported Quality of Life

Niu

Yang

et al. 2021

Preprint

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BackgroundIntervertebral fusion and internal fixation are often applied to patients with lumbar spinal disease. Whether to remove the internal fixation after successful fusion remains uncertain, but such a question needs to be explored in light of concerns regarding patients’ quality of life and health insurance. We sought to probe if the removal of internal fixation after successful lumbar intervertebral fusion affects patients’ quality of life.MethodsThis was a real-world retrospective case–control study. Data of 102 patients who had undergone posterior lumbar fusion with cage and internal fixation to treat lumbar degenerative diseases were extracted from a single center from 2012 to 2020. Fifty-one patients had undergone internal fixation removal surgery, and 51 controls who retained internal fixations were matched according to demographic and medical characteristics. The quality of life of patients based on the Medical Outcomes Study Short Form 36 (SF-36) scale and their self-assessment were surveyed.ResultsThere was no statistical difference in the overall score of the SF-36 questionnaire between the two groups, but the general health (GH) subscore was lower in the case group than in the control group (P = 0.0284). Among those patients who underwent internal fixation removal, the quality of life was improved after instrument removal as indicated by an increased overall score (P = 0.0040), physical functioning (PF) (P = 0.0045), and bodily pain (BP) (P = 0.0008). Among patients with pre-surgery discomfort, instrument removal generated better outcomes in 25% and poor outcomes in 4.2%. Among patients without pre-surgery discomfort, instrument removal generated better outcomes in 7.4% and poor outcomes in 11.1%.ConclusionAmong patients who achieved successful posterior lumbar internal fixation, whether or not to remove the fixation instruments should be evaluated carefully. In patients experiencing discomfort, instrument removal could improve their quality of life, but the benefits and risks should be comprehensively explained to these patients. Instrument removal should not be routinely performed due to its limited or even negative effect in patients who do not report discomfort before surgery.

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Is Removal of the Internal Fixation After Successful Intervertebral Fusion Necessary? A Case–control Study Based on Patient-reported Quality of Life

Niu

Yang

et al. 2021

Preprint

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“…As a result, it is possible that the scapular pain seen in UT patients is as a result of their spinal instrumentation, which has been demonstrated to elicit back pain in previous studies. [28][29][30] Anecdotally, it has been observed that some patients demonstrate an improvement in their scapular pain following instrumentation removal. Indeed, the cause of the scapular pain in UT patients is unclear and could have multiple potential etiologies.…”

Section: Discussionmentioning

confidence: 99%

“…As previously mentioned, there is anecdotal evidence of reduced scapular pain following instrumentation removal. While studies evaluating implant removal following spine surgery for indications, such as thoracolumbar spine fractures, have shown improved patient quality life and demonstrated adequate safety, [28][29][30]32,33 there remains a paucity of literature surrounding instrumentation removal in ASD patients. Available studies, however, suggest it should be approached with significant caution.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Chronic Periscapular Pain After Adult Thoracolumbar Deformity Correction and Impact on Outcomes

et al. 2021

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Objective: Extension of the posterior upper-most instrumented vertebra (UIV) into the upper thoracic (UT) spine allows for greater deformity correction and reduced incidence of proximal junction kyphosis (PJK) in adult spinal deformity (ASD) patients. However, it may be associated with chronic postoperative scapular pain (POSP). The goal of this study was to assess the relationship between UT UIV and persistent POSP, describe the pain, and assess its impact on patient disability.Methods: ASD patients who underwent multilevel posterior fusion were retrospectively identified then administered a survey regarding scapular pain and the Oswestry Disability Index (ODI), by telephone. Univariate and multivariate analysis were utilized.Results: A total of 74 ASD patients were included in the study: 37 patients with chronic POSP and 37 without scapular pain. The mean age was 70.5 years, and 63.9% were women. There were no significant differences in clinical characteristics, including mechanical complications (PJK, pseudarthrosis, and rod fracture) or reoperation between groups. Patients with persistent POSP were more likely to have a UT than a lower thoracic UIV (p = 0.018). UT UIV was independently associated with chronic POSP on multivariate analysis (p = 0.022). ODI score was significantly higher in patients with scapular pain (p = 0.001). Chronic POSP (p = 0.001) and prior spine surgery (p = 0.037) were independently associated with ODI on multivariate analysis.Conclusion: A UT UIV is independently associated with increased odds of chronic POSP, and this pain is associated with significant increases in patient disability. It is a significant clinical problem despite solid radiographic fusion and the absence of PJK.

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“…The removal of spinal implants was cautioned by Ak et al, though they showed improved pain scales on VAS in 80% of patients undergoing a second procedure for implant removal [37].…”

Section: Functional Outcomesmentioning

confidence: 99%

Temporary stabilization of unstable spine fractures

Danison

Lee

Panchal

2017

Curr Rev Musculoskelet Med

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Purpose of Review We will review the recent literature concerning the necessity of supplemental fusion to spinal instrumentation and discuss if temporal spinal fixation is a viable option for the treatment of unstable spine fractures. Advancements in minimally invasive techniques offer an alternative approach to traditional open stabilization for unstable spine fractures. The use of minimally invasive surgery offers many advantages concerning operative morbidly; fusion is not utilized and instrumentation can be removed in a delayed fashion. Recent Findings There are limited differences in amount of correction loss over time, and multiple studies report equivocal to superior results in patient's functional outcomes when comparing temporary internal stabilization to long segment instrumentation with fusion. Removal of implants can restore segmental motion. Summary Review of the literature demonstrates that temporary internal stabilization for unstable fractures is a viable option. Close clinical and radiographic follow-up is recommended to avoid delayed spinal deformity.

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Does the Removal of Spinal Implants Reduce Back Pain?

Cited by 9 publications

References 10 publications

Is Removal of the Internal Fixation After Successful Intervertebral Fusion Necessary? A Case–control Study Based on Patient-reported Quality of Life

Is Removal of the Internal Fixation After Successful Intervertebral Fusion Necessary? A Case–control Study Based on Patient-reported Quality of Life

Incidence of Chronic Periscapular Pain After Adult Thoracolumbar Deformity Correction and Impact on Outcomes

Temporary stabilization of unstable spine fractures

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