Vertebral body compression fracture after removal of pedicle screws: a report of two cases.

While the risks of pedicle screw insertion are well established, there is a paucity of reports on complications associated with implant removal. We report two cases of acute osteoporotic vertebral compression fractures of the instrumented vertebral body adjacent to the fractured vertebra due to removal of pedicle screws in two female patients previously treated for vertebral lumbar burst fractures. Both patients had experienced only mild occasional pain at the thoracolumbar junction prior to the removal of the implants. In the formerly almost asymptomatic individuals, the acute osteoporotic fractures led to persistent severe back pain despite prolonged intensive treatment. Patients must be thoroughly informed of the rare but potential risks of spinal implant removal, particularly in cases of osteoporosis. We therefore do not recommend removal of spinal implants unless there are clear clinical indications for implant removal.