Is Implant Removal After Thoracolumbar Fracture Fixation Truly Necessary? A Systematic Review and Meta-Analysis of Radiological, Functional and Safety Outcomes

Study DesignSystematic review and Meta-analysis.ObjectiveTo compare radiological, functional and safety outcomes of implant removal vs implant retention following posterior fixation of thoracolumbar (TL) fractures.MethodsFollowing PRISMA guidelines, we searched PubMed, Embase, Scopus, Web of Science, and Cochrane library from inception to October 2025. Randomised controlled trials (RCT) and comparative cohort studies comparing outcomes between planned implant removal and retention were considered. Primary outcome measures were Cobb angle correction, Oswestry Disability Index (ODI) and surgical site infection (SSI). Secondary outcomes included pain scores, kyphosis progression, reoperation rates, and patient reported outcome measures (PROM). Random effects models generated pooled mean differences (MD) and odds ratio (OR).ResultsEight studies with 571 patients met the inclusion criteria. Radiological outcomes were comparable between the groups. Improvements in Cobb angle were similar for the 2 groups [MD: 5.04°, 95% CI: 0.03-10.05 (implant removal group) vs MD 6.38°, 95% CI: 1.89-10.87 (implant retention group); <i>P</i> = .70]. Kyphosis progression also did not differ between the groups (MD: 0.41°; <i>P</i> = .37). Functional outcomes improved significantly within both groups; however, pooled ODI analysis demonstrated no between-group difference (<i>P</i> = .81). SSI rates were low across all studies, with no significant difference between the 2 groups [Odds ratio (OR)-1.42; <i>P</i> = .30). Pain scores improved similarly in both the cohorts, and the reoperation rates were infrequent and comparable.ConclusionImplant removal after healed TL fractures provides no radiological or functional advantage over implant retention for most patients. Both strategies demonstrate meaningful improvements in pain, spinal alignment and disability, with low complication rates. Implant removal may benefit in select young and symptomatic individuals; however, routine removal may not be recommended. Individualized decision-making remains essential.Level of EvidenceII.