**5. Conclusions**

In conclusion, the removal of implants after successful fusion of thoracolumbar burst fractures may be performed effectively to restore flexibility and relieve pain, but it may also lead to the progression of kyphotic deformity and surgical complications. Both surgeons and patients should be aware of the indications and have appropriate expectations of the benefits and risks of implant removal. There was no robust evidence to support the routine removal of pedicle screw instruments after the successful fusion of thoracolumbar burst fractures, which may expose the patients to unnecessary complications and costs. The potential benefits and possible risks should be weighed to support patient-specific clinical decision-making. Further research is warranted to provide more evidence to clarify this issue.

**Supplementary Materials:** The following supporting information can be downloaded at: https:// www.mdpi.com/article/10.3390/jcm12062213/s1, Table S1: Search strategies for primary databases; Table S2: Baseline characteristics of the included case reports and case series; Table S3: The reported clinical outcomes in case reports and case series.

**Author Contributions:** X.W.: Contributed substantially to conception and design, acquisition of data, analysis, and interpretation of data; drafted the article; gave final approval of the version to be published; agreed to act as a guarantor of the work. X.-D.W.: Contributed substantially to conception and design, acquisition of data, analysis, and interpretation of data; drafted the article; gave final approval of the version to be published; agreed to act as a guarantor of the work. Y.Z.: Contributed substantially to the acquisition and interpretation of data; revised it critically for valuable intellectual content; gave final approval of the version to be published; agreed to act as a guarantor of the work. Z.Z.: Contributed substantially to the acquisition and interpretation of data; revised it critically for valuable intellectual content; gave final approval of the version to be published; agreed to act as a guarantor of the work. J.J.: Contributed substantially to the acquisition and interpretation of data; revised it critically for valuable intellectual content; gave final approval of the version to be published; agreed to act as a guarantor of the work. G.L.: Contributed substantially to the acquisition and interpretation of data; revised it critically for valuable intellectual content; gave final approval of the version to be published; agreed to act as a guarantor of the work. J.L.: Contributed substantially to the acquisition and interpretation of data; revised it critically for valuable intellectual content; gave final approval of the version to be published; agreed to act as a guarantor of the work. J.S.: Contributed substantially to the acquisition and interpretation of data; revised it critically for valuable intellectual content; gave final approval of the version to be published; agreed to act as a guarantor of the work. Y.S.: Contributed substantially to conception and design, acquisition of data, analysis, and interpretation of data; revised it critically for valuable intellectual content; gave final approval of the version to be published; agreed to act as a guarantor of the work. All authors have read and agreed to the published version of the manuscript.

**Funding:** This study was supported by the Beijing Jishuitan Hospital Natural Fund Incubation Program (Grant No. ZR-202304), Beijing Municipal Science & Technology Commission (Grant No. Z191100004419007), and Beijing Jishuitan Hospital Research Funding (Grant No. XKGG201811).

**Institutional Review Board Statement:** This was a systematic review, and no ethics approval and consent to participate were required.

**Informed Consent Statement:** Not applicable.

**Data Availability Statement:** The datasets used and analyzed during the study will be available from the corresponding authors on reasonable request.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **Abbreviations**

