title: Posterior implant removal in patients with thoracolumbar spine fractures: long-term results.
abstract: Debate remains whether posterior implants after thoracolumbar spine fracture stabilization should be removed routinely or only in symptomatic cases. Implant related problems might be resolved or even prevented but removal includes secondary risks. The aim of this study was to evaluate safety, patient satisfaction and quality of life after implant removal.
  
  
  
  A retrospective cohort study was performed concerning 102 patients that underwent posterior implant removal after stabilization of a traumatic thoracolumbar fracture between 2003 and 2015. Patients were invited to fill in SF-36, EQ-5D and RMDQ questionnaires after implant removal. Additionally, questions concerning satisfaction were presented. Cobb angles before and after removal were measured and in- or decrease of symptoms was gathered from hospital charts.
  
  
  
  Mean age at removal was 38 years and time from implant removal to questionnaire was approximately 7 years, 62 patients filled in the questionnaires. Complications were present in 8% and quality of life was reported as fairly good. Patients had less back pain related disability compared to chronic low back pain patients. After removal there was a kyphosis increase which did not correspond with worsened clinical outcome. Removal decreased most symptoms and even asymptomatic patients reported benefit in most cases. An increase of symptoms after removal was reported in 11% of patients.
  
  
  
  Implant removal is generally safe and provides high patient satisfaction. Overall, patients have a fairly good quality of life. Most symptomatic and asymptomatic patients report benefit from removal. However, low risks of complications and increase of symptoms have to be weighted for individual patients.
authors.affiliation: Department of Traumasurgery, VU University Medical Centre, De Boelelaan 1117, room 7F020, 1081 HV, Amsterdam, The Netherlands. aj.smits@vumc.nl.
authors.forename: A J
authors.initials: AJ
authors.lastname: Smits
authors.affiliation: Department of Traumasurgery, VU University Medical Centre, De Boelelaan 1117, room 7F020, 1081 HV, Amsterdam, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: den Ouden
authors.affiliation: Department of Traumasurgery, VU University Medical Centre, De Boelelaan 1117, room 7F020, 1081 HV, Amsterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Jonkergouw
authors.affiliation: Department of Traumasurgery, VU University Medical Centre, De Boelelaan 1117, room 7F020, 1081 HV, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Deunk
authors.affiliation: Department of Traumasurgery, VU University Medical Centre, De Boelelaan 1117, room 7F020, 1081 HV, Amsterdam, The Netherlands.
authors.forename: F W
authors.initials: FW
authors.lastname: Bloemers
mesh_terms: D000328:Adult; D020878:Device Removal / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007738:Kyphosis; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D011795:Surveys and Questionnaires; D013904:Thoracic Vertebrae / Q000293:injuries / Q000601:surgery
keywords: Implant removal; Posterior implant; Quality of life; Thoracolumbar fracture