Metal hypersensitivity in patient with posterior lumbar spine fusion: a case report and its literature review

Shang, Xianping; Kou, Depeng; Jia, Xunyuan; Yang, Xianglong; Zhang, Meng; Tang, Yilong; Wang, Pengrui; Wang, Shijin; Xu, Yan; Wang, Hong

doi:10.1186/1471-2474-15-314

Cited by 18 publications

(20 citation statements)

References 27 publications

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“…Although considered static, these devices are subjected to micro-motion and fretting during the fusion process as well as load sharing post successful fusion which can lead to further fretting and/or hardware breakage. All of which can lead to metallic debris and subsequent hypersensitivity reaction [9]. Symptoms of implanted metal hypersensitivity can be difficult to diagnose.…”

Section: Discussionmentioning

confidence: 99%

“…Initial patient evaluation should include basic physical examination, routine laboratory testing, and imaging studies. In patients with metal hypersensitivity reactions, various imaging demonstrated peri-prosthetic tissue swelling with or without implant loosening [8][9]11]. Periprosthetic tissue samples consistently demonstrate a predominance of lymphocyte proliferation [8].…”

Section: Discussionmentioning

confidence: 99%

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Rare Systemic Response to Titanium Spinal Fusion Implant: Case Report

Towers

Kurtom²

2020

Cureus

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Neurosurgical patients with titanium spinal implant hypersensitivity can be difficult to diagnosis due to its rarity. Suspicion for titanium allergy is generally localized to the hardware site and may initially be thought to be an infectious process. Patients who report anorexia and fatigue over a long duration after the initial post-operative period may be diagnosed with depression rather than a systemic response to spinal metallic instrumentation. To our knowledge, a systemic titanium hypersensitivity reaction to spinal fixation devices has not been reported in the literature. We offer this report to give spine surgeons additional insight into suspected systemic titanium hypersensitivity symptoms which, if remain unidentified, can severely impair patient outcomes. A 67-year-old female with an unreported nickel allergy developed severe debilitating anorexia and fatigue one month post operatively, secondary to minimally invasive thoracic spinal fixation for T11 burst fracture with disruption of posterior elements. Over a two year period, weight loss reached approximately 25 kilograms with loss of muscle mass and subcutaneous tissue surrounding the spinal implants. The screws and rods were removed to avoid skin erosion. Upon hardware removal, the patient had rapid weight gain, improved stamina and generalized sense of well-being. We recommend the removal of spinal hardware in patients with suspected systemic titanium hypersensitivity reaction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rare Systemic Response to Titanium Spinal Fusion Implant: Case Report

Towers

Kurtom²

2020

Cureus

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“…Problematic responses to CoCr MoM wear particles include metal hypersensitivity, metallosis, the formation of pseudotumors, and vasculitis [15,44,46,[74][75][76]. Metal-specific biological responses are a result of wear particle chemistry and shape.…”

Section: Biological Responsementioning

confidence: 99%

Materials and Their Failure Mechanisms in Total Disc Replacement

Reeks

Liang

2015

Lubricants

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Adults suffering from lower back pain often find the cause of pain is degenerative disc disease. While non-surgical treatment is preferred, spinal fusion and total disc replacement remain surgical options for the patient. Total disc replacement is an emerging and improving treatment for degenerative discs. This paper provides a review of lumbar disc replacement for treatment of lower back pain. The mechanics and configuration of the natural disc are first discussed, followed by an introduction of treatment methods that attempt to mimic these mechanics. Total disc replacement types, materials, and failure mechanisms are discussed. Failure mechanisms primarily involve biochemical reactions to implant wear, as well as mechanical incompatibility of the device with natural spine motion. Failure mechanisms include: osteolysis, plastic deformation of polymer components, pitting, fretting, and adjacent level facet and disc degeneration.

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“…Approximately 10–15% of patients require a secondary operation due to hardware-related back pain [ 11 , 12 ]. In addition, corrosion debris and the resulting inflammatory responses around the hardware have been implicated as potential sources of pain [ 13 , 14 ]. The fretting corrosion between screws and rods can release ions and activate the immune system by forming metal-protein complexes, which could subsequently lead to metal hypersensitivity responses.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the suitability of biodegradable rods for use in posterior lumbar fusion: An in-vitro biomechanical evaluation and finite element analysis

et al. 2017

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Interbody fusion with posterior instrumentation is a common method for treating lumbar degenerative disc diseases. However, the high rigidity of the fusion construct may produce abnormal stresses at the adjacent segment and lead to adjacent segment degeneration (ASD). As such, biodegradable implants are becoming more popular for use in orthopaedic surgery. These implants offer sufficient stability for fusion but at a reduced stiffness. Tailored to degrade over a specific timeframe, biodegradable implants could potentially mitigate the drawbacks of conventional stiff constructs and reduce the loading on adjacent segments. Six finite element models were developed in this study to simulate a spine with and without fixators. The spinal fixators used both titanium rods and biodegradable rods. The models were subjected to axial loading and pure moments. The range of motion (ROM), disc stresses, and contact forces of facet joints at adjacent segments were recorded. A 3-point bending test was performed on the biodegradable rods and a dynamic bending test was performed on the spinal fixators according to ASTM F1717-11a. The finite element simulation showed that lumbar spinal fusion using biodegradable implants had a similar ROM at the fusion level as at adjacent levels. As the rods degraded over time, this produced a decrease in the contact force at adjacent facet joints, less stress in the adjacent disc and greater loading on the anterior bone graft region. The mechanical tests showed the initial average fatigue strength of the biodegradable rods was 145 N, but this decreased to 115N and 55N after 6 months and 12 months of soaking in solution. Also, both the spinal fixator with biodegradable rods and with titanium rods was strong enough to withstand 5,000,000 dynamic compression cycles under a 145 N axial load. The results of this study demonstrated that biodegradable rods may present more favourable clinical outcomes for lumbar fusion. These polymer rods could not only provide sufficient initial stability, but the loss in rigidity of the fixation construct over time gradually transfers loading to adjacent segments.

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Metal hypersensitivity in patient with posterior lumbar spine fusion: a case report and its literature review

Cited by 18 publications

References 27 publications

Rare Systemic Response to Titanium Spinal Fusion Implant: Case Report

Rare Systemic Response to Titanium Spinal Fusion Implant: Case Report

Materials and Their Failure Mechanisms in Total Disc Replacement

Assessment of the suitability of biodegradable rods for use in posterior lumbar fusion: An in-vitro biomechanical evaluation and finite element analysis

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