Delayed Hyper-Reactivity to Metal Ions After Cervical Disc Arthroplasty

Cavanaugh, David A.; Nunley, Pierce D.; Kerr, Eubulus J.; Werner, David J.; Jawahar, Ajay

doi:10.1097/brs.0b013e318195dd60

Cited by 110 publications

(53 citation statements)

References 10 publications

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“…Unlike total joint replacements, to date there is no substantial clinical retrieval history, and although the loading profiles and kinematics for these devices may have been established, they have not been clinically validated. The limited explant analyses that have been performed to date are from patients with a short clinical follow-up and have undergone revision due to recurring symptoms that likely precluded them from utilizing normal ranges of motion (ROM) [9][10][11][12][13]. In addition, the environment that a cervical arthroplasty device resides in is not truly known postoperatively, as the cervical intervertebral disc is not a synovial joint, but rather a cartilaginous joint, and similar to lumbar disc arthroplasty, much of what is speculated comes from the history of total joint arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

The use of self-mating PEEK as an alternative bearing material for cervical disc arthroplasty: a comparison of different simulator inputs and tribological environments

Brown

Bao

2012

Eur Spine J

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Purpose The hypothesis for this study was that the simulated wear behavior of a hydroxyapatite coated, selfmating PEEK cervical disc arthroplasty device would be dependent on the simulated testing environment. Methods Five groups of devices were evaluated under suggested ASTM and ISO load and motion profiles. The groups utilized different testing frequencies and protein content of simulator fluid, in addition to assessing the potential for third body wear. The average wear rates were determined using linear regression analysis with a generalized estimating equation. Significant differences between groups were determined using the Wald's test. Results The simulated wear behavior was shown to be highly dependent on the testing environment, where protein content more than decreasing the cyclic loading frequency resulted in increased wear, but was not dependent on the suggested load and motion profiles. It was demonstrated that a self-mating PEEK cervical disc arthroplasty device has wear rates that are similar to existing material combinations for cervical disc arthroplasty. Conclusions This study showed that at a time when data from retrieval analyses is deficient, it is important to test the wear resistance of cervical disc arthroplasty devices under various conditions. Long-term clinical results and ongoing implant retrievals are required for validation between clinical performance and simulator inputs.

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Section: Introductionmentioning

confidence: 99%

The use of self-mating PEEK as an alternative bearing material for cervical disc arthroplasty: a comparison of different simulator inputs and tribological environments

Brown

Bao

2012

Eur Spine J

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“…Basic science studies show local factors such as the materials surface composition and characteristics, the bacteria's ability to elaborate a protective polysaccharide coating, and the medium's composition have been reported to affect bacterial antibiotic sensitivity and host defense systems [12]. However, the environment of the intervertebral disc is not necessarily comparable to that of a peripheral synovial joint [13]. The role of prolonged oral immunosuppressive antibiotics is not well investigated.…”

Section: Case Presentationmentioning

confidence: 99%

Revision of a lumbar disc arthroplasty following late infection

Spivak

Petrizzo

2009

Eur Spine J

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Anterior removal of a lumbar total disc replacement implant is often a very technically demanding procedure. The anterior retroperitoneal anatomy is prone to scarring, limiting remobilization and making a direct anterior exposure above the L5-S1 level difficult if not impossible to achieve safely. Anterolateral approach strategies can be more safely achieved at L4-L5 and above, but may require vertebral osteotomy in order to remove a keeled prosthesis. Successful conversion to a fusion with implant removal can be achieved, even when osteotomy is needed for implant removal. This Grand Rounds case presentation involves an unusual late retroperitoneal abscess following two-level TDR with direct extension to one of the implants, and the subsequent nonoperative and operative management. Removal of a well-fixed keeled implant at the L4-L5 level following nonoperative treatment of a surrounding retroperitoneal abscess and conversion to fusion represents close to, if not a 'worst-case' scenario for revision TDR. However, with proper preoperative planning and surgical experience, a safe and successful procedure can be the end result.

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“…The periprosthetic soft tissues involved with metallosis are usually stained black. However, the case described by Cavanaugh et al [14] involved a yellowish mass without staining of the periprosthetic soft tissues. This latter case was likely due to a delayed hypersensitivity reaction rather than a metalloma induced by metallic wear debris.…”

Section: Discussionmentioning

confidence: 94%

“…This latter case was likely due to a delayed hypersensitivity reaction rather than a metalloma induced by metallic wear debris. Few metalloma have been reported after spinal disc arthroplasty, as shown in Table 1 [14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Metallosis after traumatic loosening of Bryan cervical disc arthroplasty: a case report and literature review

et al. 2017

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Purpose Cervical disc arthroplasty has been a popular alternative to traditional arthrodesis treatment for maintaining postoperative cervical spine mobility. However, certain adverse reactions to cervical disc arthroplasty have emerged during the last few decades. Methods Metallosis or metalloma is a rarely reported complication after spinal fusion or spinal arthroplasty surgery. We report on the first metallosis case occurring in a patient who received Bryan Disc implantation approximately 8 years earlier.She was involved in a traffic accident and sustained a whiplash injury to the cervical spine one and a half years ago. The traumatic Bryan Disc loosening developed after the traffic accident, causing metallosis. Results To the best of our knowledge, this is the first reported case of spinal metallosis caused by the Bryan Disc. A series of metallosis cases reported in the literature are also reviewed. Conclusions Although uncommon, intraspinal metallosis or metalloma should be considered as an infrequent cause of delayed neurological symptoms after spinal surgery involving metallic instrumentation, especially after disc arthroplasty. Once metallosis is suspected, immediate metallic implant removal is mandatory for definite diagnosis and treatment.

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Delayed Hyper-Reactivity to Metal Ions After Cervical Disc Arthroplasty

Cited by 110 publications

References 10 publications

The use of self-mating PEEK as an alternative bearing material for cervical disc arthroplasty: a comparison of different simulator inputs and tribological environments

The use of self-mating PEEK as an alternative bearing material for cervical disc arthroplasty: a comparison of different simulator inputs and tribological environments

Revision of a lumbar disc arthroplasty following late infection

Metallosis after traumatic loosening of Bryan cervical disc arthroplasty: a case report and literature review

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