Explantation of Pedicle Screws: When, Why, and How?

The insertion of pedicle screws is one of the most common procedures in neurosurgical spinal interventions. It has been used for the fixation and immobilization of spinal segments secondary to trauma or as part of complex spinal reconstruction for vertebral metastatic disease, degenerative disease, or infection. However, increasing rates of pedicle screw use may also be the cause of more frequent revision surgery. The stabilization system may become loosened or defective, which could cause instability of the segment, severe neurological deficit, and intense pain. In addition to this, the screws may be removed in case of satisfactory consolidation depending on the individual decision of the surgeon. Despite the widespread use of pedicle screw fixation, there is limited research regarding the precise circumstances that may cause the need to remove the stabilization system. To our knowledge, this is the first research item to review the causes and the exact time for removal of inserted pedicle screws, as well as to outline techniques for the explantation and the possible short- and long-term outcomes after the procedure.