title: Implant removal after posterior stabilization of the thoraco-lumbar spine.
abstract: BACKGROUND
  Implant removal because of pain after posterior fusion in the thoracic and lumbar spine is a widely performed operation. We conducted a retrospective study to examine whether patients benefit from implant removal.
  
  
  METHODS
  57 patients (29 males, 28 females, mean age 46.5 years) who have undergone removal of pedicle screws because of pain and discomfort were interviewed 6-24 months postoperatively. Fracture was the initial diagnosis in 40% of the patients and degenerative spine disease in 58%. The following factors were evaluated: patient satisfaction and postoperative outcome, patients' native language and psychological background, operative data, hospital stay and complications.
  
  
  RESULTS
  Pain decreased significantly from 62 to 48 on visual analogue scale postoperatively. Complications occurred in five patients (8.8%). 36 patients (61%) stated they had some benefit from the operation, but only seven patients (12%) were free of pain completely. 36 patients (63%) would undergo the same procedure again. Outcome in the subgroup of foreigners was significantly worse, though the psychological background did not affect the outcome. Preoperative diagnostic infiltration was helpful in 9 of 13 patients.
  
  
  CONCLUSIONS
  Removal of pedicle screws because of back pain may be effective, but complete remission of symptoms could be achieved in only 12% of patients. However, 63% of patients would undergo hardware removal again. Preoperative diagnostic infiltration can help to predict the outcome but results are inconsistent. Communication difficulties may worsen the outcome. Surgeons should consider these results when planning implant removal and patients should be informed thoroughly to avoid too high expectations.
authors.affiliation: First Orthopaedic Department, G. Papanikolaou Gen. Hospital, Aristotle University of Thessaloniki, Exohi, Thessaloniki, Greece.
authors.forename: Stavros I
authors.initials: SI
authors.lastname: Stavridis
authors.forename: Petra
authors.initials: P
authors.lastname: Bücking
authors.forename: Stefan
authors.initials: S
authors.lastname: Schaeren
authors.forename: Bernhard
authors.initials: B
authors.lastname: Jeanneret
authors.forename: Klaus John
authors.initials: KJ
authors.lastname: Schnake
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology*; D016009:Chi-Square Distribution; D020878:Device Removal; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation; D018709:Statistics, Nonparametric; D013904:Thoracic Vertebrae / Q000293:injuries / Q000601:surgery; D016896:Treatment Outcome