Abstract
Purpose
To document a rarely reported complication associated with spinal instrumentation and to evaluate the current literature on spinal metallosis and spinal metalloma.
Methods
A local case report is presented. EBSCOhost, PubMed and ScienceDirect databases were used to conduct a systematic review for articles describing spinal metallosis and spinal metalloma.
Results
A total of 836 articles were identified using the terms “metalloma” or “metallosis”. Exclusion of arthroplasty-related abstracts retrieved 46 articles of which 3 full text articles presenting spinal metalloma as a causative pathological finding responsible for neurological signs and symptoms in patients with previous spinal fusion instrumentation were reviewed. Our case is the first described with titanium-composed posterior instrumentation and fifth reported, demonstrating the phenomena of neurological symptoms and signs attributed directly to neural tissue compression by spinal metalloma after spinal instrumentation.
Conclusion
Spinal metallosis can present weeks to years after spinal instrumentation surgery and is a potential cause of neural compression. This process appears to be independent of the instrument composition as metallosis has now been demonstrated in both titanium and stainless steel constructs.
Similar content being viewed by others
References
Harrington PR (1962) Treatment of scoliosis. Correction and internal fixation by spine instrumentation. J Bone Joint Surg Am 44:591–610
Bago J, Ramirez M, Pellise F et al (2003) Survivorship analysis of Cotrel–Dubousset instrumentation in idiopathic scoliosis. Eur Spine J 12:435–439
Fernandez-Baillo N, Sanchez JMS, Gallego EC et al (2012) Intraspinal metalloma causing lumbar stenosis after interbody fusion with cylindrical cages. Acta Orthop Belg 78:811–814
Francois J, Coessens R, Lauweryns P (2007) Early removal of a Maverick disc prosthesis: surgical findings and morphological changes. Acta Orthop Belg 73:122–127
Guyer RD, Shellock J, Maclennan B et al (2011) Early failure of metal-on-metal artificial disc prostheses associated with lymphocytic reaction: diagnosis and treatment experience in four cases. Spine 36:E492–E497
Takahashi S, Delecrin J, Passuti N (2001) Intraspinal metallosis causing delayed neurologic symptoms after spinal instrumentation surgery. Spine 26:1495–1498
Tezer M, Kuzgun U, Hamzaoglu A et al (2005) Intraspinal metalloma resulting in late paraparesis. Arch Orthop Trauma Surg 125:417–421
Black J, Sherk H, Bonini J et al (1990) Metallosis associated with a stable titanium-alloy femoral component in total hip replacement: a case report. J Bone Joint Surg Am 72:126–130
Korovessis P, Ptsinis G, Repanti M et al (2006) Metallosis after contemporary metal-on-metal total hip arthroplasty. Five to nine-year follow up. J Bone Joint Surg 88-A:1183–1191
Matziolis G, Perka C, Disch A (2003) Massive metallosis after revision of a fractured ceramic head onto a metal head. Arch Orthop Trauma Surg 123:48–50
Sanchis-Alfonso V (2007) Severe metallosis after unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 15:361–364
Berguiristain J, Del Rio J, Duart J et al (2006) Corrosion and late infection causing delayed paraparesis after spinal instrumentation. J Pediatr Orthop B 15:320–323
Clark CR, Shufflebarger HL (1999) Late developing infection in instrumented idiopathic scoliosis. Spine 24:1909–1912
Jacobs JJ, Gilberte JL, Urban RM (1998) Corrosion of metal orthpaedic implants. J Bone Joint Surg 80-A:268–282
Pienkowski D, Stephens GC, Doers TM et al (1998) Multicycle mechanical performance of titanmium and stainless steel transpendicular spine implants. Spine 23:782–788
Del Rio J, Berguiristain J, Duart J (2007) Metal levels in corrosion of spinal implants. Eur Spine J 16:1055–1061
Muschik M, Luck W, Schlenzka D (2004) Implant removal for late-developing infection after instrumented posterior spinal fusion for scoliosis: reinstrumentation reduces loss of correction. A retrospective analysis of 45 cases. Eur Spine J 13:645–651
Waelchli B, Min K, Cathrein P et al (2002) Vertebral body compression fracture after removal of pedicle screws: a report of two cases. Eur Spine J 11:504–506
Akazawa T, Minami S, Takahashi K et al (2005) Corrosion of spinal implants retrieved from patients with scoliosis. J Orthop Sci 10:200–205
Aulisa L, Di Benedetto A, Vinciguerra A et al (1982) Corrosion of the Harrington’s instrumentation and biological behavior of the rod-human spine system. Biomaterials 3:246–248
Bono C, Lee C (2004) Critical analysis of trends in fusion for degenerative disc disease over the past 20 years: influence of technique on fusion rate and clinical outcome. Spine 29:455–463
Fritzell P, Hagg O, Wessberg P et al (2002) Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish lumbar spine study group. Spine (Phila Pa 1976) 27:1131–1141
Kapur RA, Amirfeyz R, Wylde V et al (2010) Clinical outcomes and fusion success associated with the use of BoneSave in spinal surgery. Arch Orthop Trauma Surg 130:641–647
Kim YJ, Kassab F, Berven SH et al (2005) Serum levels of nickel and chromium after instrumented posterior arthrodesis. Spine 30:923–926
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Rights and permissions
About this article
Cite this article
Goldenberg, Y., Tee, J.W., Salinas-La Rosa, C.M. et al. Spinal metallosis: a systematic review. Eur Spine J 25, 1467–1473 (2016). https://doi.org/10.1007/s00586-015-4347-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-015-4347-6