Neurological emergency from rare spinal metalloma: Case report and literature review

Mazur-Hart, David J.; Larson, Erik W.; Yaghi, Nasser K.; Halfpenny, Aaron; Pettersson, David; Yam, David A.

doi:10.1016/j.radcr.2022.01.041

Cited by 2 publications

(2 citation statements)

References 34 publications

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“…They also noted high serum chromium levels. Most recently, Mazur-Hart et al [ 10 ] reported a case of unilateral metalloma from mixed-metal (titanium and cobalt chrome) instrumentation that resulted in progressive neurological deficit, but not hardware failure. Another unusual finding was the absence of metallosis on the side where the patient had also undergone a hip arthroplasty comprising of the same materials.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent clinical trial by Spirig et al [ 14 ], CT was more sensitive and specific in detecting screw loosening despite applying metal artifact reduction techniques with MRI. However, MRI may be of utility in cases where the metalloma is large enough with compression or extension into surrounding structures, such as in the cases reported by Li et al [ 7 ] and Mazur-Hart et al [ 10 ]. Comparing plain radiographs and CT findings of previous studies (Table 1 ), we suggest adopting a high index of suspicion of metallosis when screw loosening is evident on radiographical imaging in a patient with persistent postoperative back pain or radiculopathy but otherwise medically well.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Metallosis with spinal implant loosening after spinal instrumentation: A case report

Kwan,

Teo,

Dinesh

et al. 2023

World J Orthop

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Periprosthetic joint infection (PJI) is a rare but terrible complication in hip and knee arthroplasty, and the use of topical vancomycin powder (VP) has been investigated as a tool to potentially reduce its incidence. However, there remains no consensus on its efficacy. Therefore, the aim of this review is to provide an overview on the application of topical vancomycin in orthopaedic surgery focusing on the recent evidence and results in total joint arthroplasty. Several systematic reviews and meta-analyses on topical VP in hip and knee arthroplasty have been recently published reporting sometimes conflicting results. Apart from all being limited by the quality of the included studies (mostly level III and IV), confounding variables are often included potentially leading to biased conclusions. If taken into consideration the exclusive use of VP in isolation, the available data, although very limited, suggest that it does not reduce the infection rate in routine primary hip and knee arthroplasty. Therefore, we still cannot advise for a routinary application. A properly powered randomized-controlled trial would be necessary to clarify the role of VP in hip and knee arthroplasty. Based on the analysis of the current evidence, the use of topical VP appears to be safe when used locally in terms of systemic adverse reactions, hence, if proven to be effective, it could bring great benefits due to its low cost and accessibility.

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Section: Discussionmentioning

confidence: 99%