The removal of the pedicle screw tool is usually considered a simple and benign process in spinal surgical procedures. Implant removal may alleviate worries about the dangers of metal indwelling, such as micromotion, metal fretting, allergic reaction, infection, or stress-induced osteopenia [3, 4]. Furthermore, removing the pedicle screw reduces the rigidity of the fused segment, which may reduce stress concentration at surrounding segments [5, 6]. Pedicle screw removal, on the other hand, is a second surgical procedure conducted under general anesthesia, with associated morbidity concerns such as operative site infection, neurovascular damage, and refracture.

Problems associated to the construct used in spinal deformity surgery are common. Loosening/breakage of the implant with loss of fixation, pseudarthrosis, neighboring segment disease, and surgical site infection are all common clinical situations. Revision procedures are frequently required as a result of these problems. Revision operations are becoming more common as time has passed since these systems were introduced. The removal or replacement of prior implants, with or without the addition of new implants, may be included in such revision operations. Some commonly used implants may be removed with universal screwdrivers, whereas other systems require the use of specialised equipment. It's crucial to know which implant systems were employed in earlier procedures. Despite the vast range of implant designs in use, information regarding the precise implant utilized are not always noted in operative reports, and in some cases, operative reports are not even available, such as when surgeries are performed in remote locations or revisions are required on an emergency basis. As a result, a preoperative radiographic evaluation of the prior construct is required as part of the preparation process [2].

The rates of posterior thoracolumbar implant removal are mostly unknown. It's also debatable how much assistance patients receive. Only 12% of individuals who have had their implants removed will experience complete symptom remission. Patients who will have implants removed should be reminded not to have unrealistic expectations, according to the same article. In many circumstances, however, the removal of spinal implants is unavoidable [1]. In contrary to literature data, pain alleviation was observed in 290 of 314 patients (92.35%) in the early postoperative period of 2 weeks [7]. However, during the postoperative 3rd month follow-up, 45 patients reported partial recurrence of pain. All patients were advised to wear a steel underwire corset in the first 2 months after PSI removal.

In case of need for iimplant removal, challenges may arise due to tool incompatibility during the procedure. The removal procedure we have described seems to be practical and safe yielding satisfactory outcomes. Before performing this novel procedure, we used to end the intervention without removal of the implants. We suggest that this method can be simply and successfully employed to any posterior screw-rod systems.

“Orthopedically damaged screw removal sets” are offered according to recent marketing brochures distributed by a spinal instrument manufacturer. Only a 2 cm section of the posterior spinal rod that we cut during surgery plays a critical role in the effectiveness of the surgery. Thus, there is no need to employ sets including a huge number of newly released instruments.

Implant removal after successful fusion was advantageous in our present study with thoracolumbar burst fractures because it greatly reduced pain and impairment. The exact process by which clinical improvement occurs following implant removal is unknown. Implant-related pain has been linked to micromotion, metal fretting, allergic reaction, low-grade infection, and/or stress concentration in the neighboring segment [5, 6, 8]. Implant removal and fusion exploration may be an acceptable therapy to try to reduce pain in patients who report with recurrent persistent back pain and no other identifiable causes shown to be pain generators. However, there is scarce data on the implications of removal of hardware following instrumented spinal fusions.

The removal of spine implants for pain management in solid fusion patients has been a point of contention. The relevance of spinal implant removal in the therapy of prolonged pain and symptoms following spinal fusion remains unclear. The exact method by which the implant causes discomfort is still unknown. The rationale and outcomes of removing a spinal implant in terms of pain management are unknown. The removal of equipment is typically seen to be a reasonably benign process, despite the fact that the outcome appears to be uncertain. As a result, neurosurgeons will consider removing equipment to help patients with their problems [9]. The morbidity associated with undergoing an additional surgery is a final factor when evaluating the value of implant removal. Perioperative risk varies from patient to patient, but this adds to the complexity of the surgeon–patient clinical decision [7].

Aono et al. [10] claim that using titanium as a screw material reduces the chance of early instrument fixation failure because the material used can affect the risk of failure. Titanium has two times the strength and flexibility of typical stainless steel [11]. According to another study, utilizing pedicle screws with the largest diameter possible can also help prevent failure [12].

Implant removal is supposed to be a safe procedure with satisfactory outcomes with improvement of quality of life [13]. Majority of patients report benefit from removal of the implant [13]. We hope our novel technique can be a safe, cost-effective, and practical method in selected patients scheduled for removal.

The main restrictions of the present paper include retrospective and single-center design, variability of outcomes with different implant brands. Moreover, the implant removal was not performed in a completely random manner and inclusion of study subjects may result in selection bias. The cost-effectiveness of implant removal procedure was not assessed and the decision to remove pedicle screws has significant financial ramifications, given the costs of the treatment under general anesthesia as well as time off for postoperative rehabilitation. Other social, economic, and psychosocial elements that could have influenced clinical results must be remembered during extrapolation of our data to larger populations. More research is needed to understand if any of these characteristics influence the clinical outcome in patients with healed thoracolumbar burst fractures after pedicle screw removal.