4.3.2. Segmental Range of Motion

Improvement of the segmental range of motion has been recognized as one of the major benefits of implant removal, especially in patients who received pedicle screw fixation without fusion. Several previous studies have confirmed the advantages of implant removal for the preservation of segmental motion, which can further alleviate pain and disability [38,44–47,58] and lead to decreases in the pain intensity score and ODI score [39,41,44,56,59,63]. Therefore, these clinical benefits after implant removal are measurable and demonstrate that a subgroup of patients would benefit from implant removal, especially when there was no disastrous kyphosis deformity recurrence. Nonetheless, we should also realize that the actual mobility of the segment has possible implications—both positive and negative. The improved range of motion of the fractured segment in the thoracolumbar junction would unload the stress on the adjacent segments but put stress on the fractured vertebra and nearby discs. Hence, the improved segmental range of motion also means an unstable status after implant removal, with a potential risk of recurrent kyphosis deformity induced by destabilization after implant removal [37].
