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Removal or retention of minimally invasive screws in thoracolumbar fractures? Systematic review and case–control study

BACKGROUND: There is uncertainty regarding delayed removal versus retention of minimally invasive screws following percutaneous fixation for thoracolumbar fractures. We conducted a systematic review and case–control study to test the hypothesis that delayed metalwork removal following percutaneous f...

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Autores principales: Visagan, Ravindran, Kearney, Siobhan, Trifoi, Sebastian, Kalyal, Nida, Hogg, Florence, Quercetti, Beatrice, Abdalla, Mohamed, Danciut, Mihai, Papadopoulos, Marios C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10068661/
https://www.ncbi.nlm.nih.gov/pubmed/36790587
http://dx.doi.org/10.1007/s00701-023-05514-9
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author Visagan, Ravindran
Kearney, Siobhan
Trifoi, Sebastian
Kalyal, Nida
Hogg, Florence
Quercetti, Beatrice
Abdalla, Mohamed
Danciut, Mihai
Papadopoulos, Marios C.
author_facet Visagan, Ravindran
Kearney, Siobhan
Trifoi, Sebastian
Kalyal, Nida
Hogg, Florence
Quercetti, Beatrice
Abdalla, Mohamed
Danciut, Mihai
Papadopoulos, Marios C.
author_sort Visagan, Ravindran
collection PubMed
description BACKGROUND: There is uncertainty regarding delayed removal versus retention of minimally invasive screws following percutaneous fixation for thoracolumbar fractures. We conducted a systematic review and case–control study to test the hypothesis that delayed metalwork removal following percutaneous fixation for thoracolumbar fractures improves outcome. METHODS: A systematic review was performed in accordance with the PRISMA guidelines. Our case–control study retrospectively evaluated 55 consecutive patients with thoracolumbar fractures who underwent percutaneous fixation in a single unit: 19 with metalwork retained (controls) and 36 with metalwork removed. Outcomes were the Oswestry Disability Index (ODI), a supplemental questionnaire, and complications. RESULTS: The systematic review evaluated nine articles. Back pain was reduced in most patients after metalwork removal. One study found no difference in the ODI after versus before metalwork removal, whereas three studies reported significant improvement. Six studies noted no significant alterations in radiological markers of stability after metalwork removal. Mean complication rate was 1.7% (0–6.7). Complications were superficial wound infection, screw breakage at the time of removal, pull-out screw, and a broken rod. In the case–control study, both groups were well matched. For metalwork removal, mean operative time was 69.5 min (range 30–120) and length of stay was 1.3 days (0–4). After metalwork removal, 24 (68.6%) patients felt better, 10 (28.6%) the same and one felt worse. Two patients had superficial hematomas, one had a superficial wound infection, and none required re-operation. Metalwork removal was a significant predictor of return to work or baseline household duties (odds ratio 5.0 [1.4–18.9]). The ODI was not different between groups. CONCLUSIONS: The findings of both the systematic review and our case–control study suggest that removal of metalwork following percutaneous fixation of thoracolumbar fractures is safe and is associated with improved outcome in most patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00701-023-05514-9.
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spelling pubmed-100686612023-04-04 Removal or retention of minimally invasive screws in thoracolumbar fractures? Systematic review and case–control study Visagan, Ravindran Kearney, Siobhan Trifoi, Sebastian Kalyal, Nida Hogg, Florence Quercetti, Beatrice Abdalla, Mohamed Danciut, Mihai Papadopoulos, Marios C. Acta Neurochir (Wien) Original Article - Spine trauma BACKGROUND: There is uncertainty regarding delayed removal versus retention of minimally invasive screws following percutaneous fixation for thoracolumbar fractures. We conducted a systematic review and case–control study to test the hypothesis that delayed metalwork removal following percutaneous fixation for thoracolumbar fractures improves outcome. METHODS: A systematic review was performed in accordance with the PRISMA guidelines. Our case–control study retrospectively evaluated 55 consecutive patients with thoracolumbar fractures who underwent percutaneous fixation in a single unit: 19 with metalwork retained (controls) and 36 with metalwork removed. Outcomes were the Oswestry Disability Index (ODI), a supplemental questionnaire, and complications. RESULTS: The systematic review evaluated nine articles. Back pain was reduced in most patients after metalwork removal. One study found no difference in the ODI after versus before metalwork removal, whereas three studies reported significant improvement. Six studies noted no significant alterations in radiological markers of stability after metalwork removal. Mean complication rate was 1.7% (0–6.7). Complications were superficial wound infection, screw breakage at the time of removal, pull-out screw, and a broken rod. In the case–control study, both groups were well matched. For metalwork removal, mean operative time was 69.5 min (range 30–120) and length of stay was 1.3 days (0–4). After metalwork removal, 24 (68.6%) patients felt better, 10 (28.6%) the same and one felt worse. Two patients had superficial hematomas, one had a superficial wound infection, and none required re-operation. Metalwork removal was a significant predictor of return to work or baseline household duties (odds ratio 5.0 [1.4–18.9]). The ODI was not different between groups. CONCLUSIONS: The findings of both the systematic review and our case–control study suggest that removal of metalwork following percutaneous fixation of thoracolumbar fractures is safe and is associated with improved outcome in most patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00701-023-05514-9. Springer Vienna 2023-02-15 2023 /pmc/articles/PMC10068661/ /pubmed/36790587 http://dx.doi.org/10.1007/s00701-023-05514-9 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article - Spine trauma
Visagan, Ravindran
Kearney, Siobhan
Trifoi, Sebastian
Kalyal, Nida
Hogg, Florence
Quercetti, Beatrice
Abdalla, Mohamed
Danciut, Mihai
Papadopoulos, Marios C.
Removal or retention of minimally invasive screws in thoracolumbar fractures? Systematic review and case–control study
title Removal or retention of minimally invasive screws in thoracolumbar fractures? Systematic review and case–control study
title_full Removal or retention of minimally invasive screws in thoracolumbar fractures? Systematic review and case–control study
title_fullStr Removal or retention of minimally invasive screws in thoracolumbar fractures? Systematic review and case–control study
title_full_unstemmed Removal or retention of minimally invasive screws in thoracolumbar fractures? Systematic review and case–control study
title_short Removal or retention of minimally invasive screws in thoracolumbar fractures? Systematic review and case–control study
title_sort removal or retention of minimally invasive screws in thoracolumbar fractures? systematic review and case–control study
topic Original Article - Spine trauma
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10068661/
https://www.ncbi.nlm.nih.gov/pubmed/36790587
http://dx.doi.org/10.1007/s00701-023-05514-9
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