Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지

Efficacy of Spinal Implant Removal after Thoracolumbar Junction Fusion

  • Kim, Seok-Won (Department of Neurosurgery College of Medicine Chosun University) ;
  • Ju, Chang-Il (Department of Neurosurgery College of Medicine Chosun University) ;
  • Kim, Chong-Gue (Department of Neurosurgery College of Medicine Chosun University) ;
  • Lee, Seung-Myung (Department of Neurosurgery College of Medicine Chosun University) ;
  • Shin, Ho (Department of Neurosurgery College of Medicine Chosun University)
  • Published : 2008.03.18
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: The purpose of this study was to evaluate the efficacy of spinal implant removal and to determine the possible mechanisms of pain relief. Methods: Fourteen patient~with an average of 42 years (from 22 to 67 years) were retrospectively evaluated. All patients had posterior spinal instrumentation and fusion, who later developed recurrent back pain or persistent back pain despite a solid fusion mass. Patients' clinical charts, operative notes, and preoperative x-rays were evaluated. Relief of pain was evaluated by the Visual Analog Scale (VAS) pain change after implant removal. Clinical outcome using VAS and modified MacNab's criteria was assessed on before implant removal, 1 month after implant removal and at the last clinical follow-up. Radiological analysis of sagittal alignment was also assessed. Results: Average follow-up period was 18 months (from 12 to 25 months). There were 4 patients who had persistent back pain at the surgical site and 10 patients who had recurrent back pain. The median time after the first fusion operation and the recurrence of pain was 6.5 months (from 3 to 13 months). All patients except one had palpation pain at operative site. The mean blood loss was less than 100ml and there were no major complications. The mean pain score before screw removal and at final follow up was 6.4 and 2.9, respectively (p<0.005). Thirteen of the 14 patients were graded as excellent and good according to modified MacNab's criteria. Overall 5.9 degrees of sagittal correction loss was observed at final follow up, but was not statistically significant. Conclusion: For the patients with persistent or recurrent back pain after spinal instrumentation, removal of the spinal implant may be safe and an efficient procedure for carefully selected patients who have palpation pain and are unresponsive to conservative treatment.

Keywords

References

  1. Cook S, Asher M, Lai SM, Shobe J : Reoperation after primary posterior instrumentation and fusion for idiopathic scoliosis. Toward defining late operative site pain of unknown cause. Spine 15 : 463-468, 2000
  2. Deckey JE, Court C, Bradford DS : Loss of sagittal plane correction after removal of spinal implants. Spine 25 : 2453-2460, 2000 https://doi.org/10.1097/00007632-200010010-00006
  3. DePalma AF, Rothman RH : The nature of pseudoarthrosis. Clin Orthop Relat Res 59 : 113-118, 1968
  4. Diwan AD, Parvartaneni H, Cammisa F : Failed degenerative lumbar spine surgery. Orthop Clin North Am 34 : 309-324, 2003 https://doi.org/10.1016/S0030-5898(03)00028-2
  5. Gaine WJ, Andrew SM, Chadwick P, Cooke E, Williamson JB : Late operative site pain with isola posterior instrumentation requiring implant removal : infection or metal reaction? Spine 26 : 583-587, 2001 https://doi.org/10.1097/00007632-200103010-00027
  6. Hume M, Capen DA, Nelson RW, Nagelberg S, Thomas JC Jr : Outcome after Wiltse pedicle screw removal. J Spinal Disord 9 : 121-124, 1996
  7. Malter AD, McNeney B, Loeser JD, Deyo RA : 5-year reoperation rates after different types of lumbar spine surgery. Spine 23 : 814-820, 1998 https://doi.org/10.1097/00007632-199804010-00015
  8. Waguespack A, Schofferman J, Slosar P, Reynolds J : Etiology of long-term failures of lumbar spine surgery. Pain Med 3 : 18-22, 2002 https://doi.org/10.1046/j.1526-4637.2002.02007.x
  9. Wild A, Pinto MR, Butler L, Bressan C, Wroblewski JM : Removal of lumbar instrumentation for the treatment of recurrent low back pain in the absence of pseudarthrosis. Arch Orthop Trauma Surg 123 : 414-418, 2003 https://doi.org/10.1007/s00402-003-0561-5