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Sattari SA, Xia Y, Azad TD, Caraway CA, Chang L. Advances in Implant Technologies for Spine Surgery. Neurosurg Clin N Am 2024; 35:217-227. [PMID: 38423737 DOI: 10.1016/j.nec.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Spine implants are becoming increasingly diversified. Taking inspiration from other industries, three-dimensional modeling of the spinal column has helped meet the custom needs of individual patients as both en bloc replacements and pedicle screw designs. Intraoperative tailoring of devices, a common need in the operating room, has led to expandable versions of cages and interbody spacers.
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Affiliation(s)
- Shahab Aldin Sattari
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Yuanxuan Xia
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Tej D Azad
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, 6007 Zayed Tower, Baltimore, MD 21287, USA
| | - Chad A Caraway
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Louis Chang
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
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Dadkhahfar S, Chehrassan M, Faldini C. Hypersensitivity reactions to metals in spine surgery. Musculoskelet Surg 2023; 107:29-35. [PMID: 36344900 DOI: 10.1007/s12306-022-00765-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022]
Abstract
Hypersensitivity to orthopedic devices is a rare condition with an underestimated incidence due to the lack of diagnostic guideline and ambiguous clinical manifestations. Although hypersensitivity to metal is common, a few cases of hypersensitivity reactions have been reported after spinal instrumentation. Spinal fusion and stabilization require a wide range of devices such as screws, wires, bands, and artificial disk replacement devices. Spinal instrumented surgeries are different from total joint arthroplasty in several aspects such as degree and pattern of motion, loading environment, and adjacent tissues with distinct characteristics. The interval for hypersensitivity reactions to occur after spinal metallic implantation is usually weeks to months. The present review covers the topic of hypersensitivity reactions that have been reported after spinal surgeries with the focus on cutaneous presentations.
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Affiliation(s)
- S Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Chehrassan
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - C Faldini
- Istituto Orthopedico Rizzoli, Bologna, Italy
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Neurological emergency from rare spinal metalloma: Case report and literature review. Radiol Case Rep 2022; 17:1540-1548. [PMID: 35282321 PMCID: PMC8908052 DOI: 10.1016/j.radcr.2022.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 11/22/2022] Open
Abstract
Metallosis is a rare and poorly understood long-term complication of instrumented surgery that can result in an inflammatory pseudotumor termed metalloma. We describe a particularly unique case and compare it to 6 analogous cases identified by PubMed and/or Medline search through July 2020. A 79-year-old male with multiple prior spinal lumbar fusion procedures presented with progressive weakness and pain. Imaging revealed a large mass surrounding the right-sided paraspinal rod with extension into the spinal canal, neural foramina, extraforaminal spaces, psoas muscle, marrow spaces, and right sided pedicles. The case presented is a unique example of a unilateral metalloma with mixed-metal instrumentation that created a progressive neurologic deficit without infection, pseudoarthrosis, or hardware failure. This case highlights the lack of understanding regarding the pathophysiology of metallosis and metalloma in spinal instrumentation. We highlight the imaging findings of metalloma to encourage early identification for removal and decompression.
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Saini H, Wang AY, Kosarchuk JJ, Yigitbilek F, Kouhsari LM, Arkun K, Riesenburger RI, Safain MG. Metal allergy hypersensitivity after posterior thoracic spinal fusion: A case report and review of the literature. Surg Neurol Int 2021; 12:635. [PMID: 35350829 PMCID: PMC8942188 DOI: 10.25259/sni_1139_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Spine surgeons rarely consider metal allergies when placing hardware, as implants are thought to be inert. Case Description: A 32-year-old male presented with a skin rash attributed to the trace metal in his spinal fusion instrumentation. Patch testing revealed sensitivities to cobalt, manganese, and chromium. He underwent hardware removal and replacement with constructs of commercially pure titanium. His skin findings resolved at 2 weeks after surgery and were stable at 6 weeks. Conclusion: Hypersensitivity to metal (i.e., metal allergy) should be considered before performing instrumented spinal fusions.
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Affiliation(s)
- Harleen Saini
- Department of Neurosurgery Tufts Medical Center, Boston, Massachusetts, United States
| | - Andy Y. Wang
- Department of Neurosurgery Tufts Medical Center, Boston, Massachusetts, United States
| | - Jacob J. Kosarchuk
- Department of Neurosurgery Tufts Medical Center, Boston, Massachusetts, United States
| | - Furkan Yigitbilek
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, United States
| | - Laleh Montaser Kouhsari
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, United States
| | - Knarik Arkun
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, United States
| | - Ron I. Riesenburger
- Department of Neurosurgery Tufts Medical Center, Boston, Massachusetts, United States
| | - Mina G. Safain
- Department of Neurosurgery Tufts Medical Center, Boston, Massachusetts, United States
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Abstract
There is an ongoing desire for the development of motion-preserving facet replacement devices as an alternative to rigid fixation in hopes of better preserving the natural kinematics of the lumbar spine. Theoretically, such a construct would simultaneously address pain associated with spinal instability and prevent abnormal load distribution and adjacent segment degeneration. Several such devices have been developed including the Anatomic Facet Replacement System, the Total Facet Arthroplasty System, and the Total Posterior Arthroplasty System. Of these devices, none have yet proven to be more efficacious than rigid fixation for lumbar spinal stenosis, and studies are ongoing.
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Dordunoo D, Anaman-Torgbor J, Smith C, Shaik A, Hass M, Gordon C, An M, Aviles-G ML, Weinzierl M. Hypersensitivity in patients receiving metal implants: a scoping review protocol. JBI Evid Synth 2021; 19:1404-1411. [PMID: 33278266 DOI: 10.11124/jbies-20-00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this scoping review is to gather the available evidence on metal hypersensitivity to determine the extent of the problem and identify gaps in the evidence about screening practices. INTRODUCTION Hypersensitivity to metal was first reported in 1966. Since this time, the use of metal in prosthetic devices has increased with an associated rise in reported hypersensitivity reaction to other metals. Symptoms of metal hypersensitivity can be subtle, and it is unclear whether clinicians are aware of or routinely ask patients about metal hypersensitivity when documenting allergies. This can lead to a delay in diagnosis, which puts patients at risk of poor outcomes. Hence, there is a need to map the available evidence on hypersensitivity reaction in people who receive metallic device implantation. INCLUSION CRITERIA The review will consider studies that include patients who undergo procedures involving metal implantation. The concept to be explored is hypersensitivity following a procedure that involves the implementation of a device with metal components. Implementation is defined as permanent integration of a foreign (non-biological) object into the human body to restore function. METHODS The proposed scoping review will be conducted in accordance with JBI methodology for scoping reviews. Searches will be generated in multiple databases and updated as needed. Gray literature and organizational websites will also be searched. Titles, abstracts, and full articles will be screened according to the inclusion criteria. Studies published in English from 1960 to the present will be included. Data will be extracted and findings will be presented in tabular form with a narrative summary.
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Affiliation(s)
- Dzifa Dordunoo
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada.,The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Health (CEiNHC): A JBI Affiliated Group, Victoria, BC, Canada
| | - Judith Anaman-Torgbor
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Catherine Smith
- Faculty of Health Sciences, University of the Fraser Valley, Chilliwack, BC, Canada
| | - Ajijoon Shaik
- School of Nursing, Camosun College, Victoria, BC, Canada
| | | | - Carol Gordon
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada.,The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Health (CEiNHC): A JBI Affiliated Group, Victoria, BC, Canada
| | - Minjeong An
- College of Nursing, Chonnam National University, Chonnam, South Korea
| | - Martha L Aviles-G
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Miriam Weinzierl
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada
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Metal Hypersensitivity in Joint Arthroplasty. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202103000-00007. [PMID: 33720103 PMCID: PMC7963506 DOI: 10.5435/jaaosglobal-d-20-00200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/31/2021] [Indexed: 11/18/2022]
Abstract
Metal hypersensitivity in joint arthroplasty is a very controversial topic with limited evidence. With increasing numbers of joint replacements being done annually, a clear understanding of the pathogenesis, clinical picture, preimplant screening, postimplant workup, and treatment plan is crucial. This review article looked at all the available evidence regarding metal hypersensitivity and summarized the key findings. An algorithm was also proposed for preimplant screening, postimplant workup, and management.
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Dordunoo D, Hass M, Smith C, Aviles-Granados ML, Weinzierl M, Anaman-Torgbor JA, Shaik A, Mallidou A, Adib F. Metal hypersensitivity screening among frontline healthcare workers-A descriptive study. J Clin Nurs 2020; 30:541-549. [PMID: 33237599 DOI: 10.1111/jocn.15571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/16/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES The study aims were to (a) assess allergy screening practices, (b) determine the awareness of metal hypersensitivity among frontline healthcare workers and (c) examine perceived barriers to implementing metal hypersensitivity screening into clinical practice. BACKGROUND Adverse device-related events, such as hypersensitivity to metals, are well documented in the literature. Hypersensitivity to metal is a type IV T-cell-mediated reaction that can occur after cardiac, orthopaedic, dental, gynaecological and neurosurgical procedures where a device with metal components is implanted into the body. Patients with hypersensitivity to metal are likely to experience delayed healing, implant failure and stent restenosis. Identifying patients with a history of metal hypersensitivity reaction could mitigate the risk of poor outcomes following device implant. Yet in clinical practice, healthcare workers do not routinely ask about the history of metal hypersensitivity when documenting allergies. The existing literature does not report why this is not included in allergy assessment. DESIGN Following the STROBE checklist, a cross-sectional, descriptive study was conducted. METHODS Frontline healthcare workers were recruited using professional contacts and social online media to complete an online questionnaire. Quantitative data were summarised descriptively while thematic analysis was used to examine barriers to implementation. RESULTS Three hundred forty-five participants from 14 countries completed the questionnaire, with the majority (187/54%) practicing in Canada, in general medicine and intensive care units. Ninety per cent of the participants did not routinely ask about metal hypersensitivity when evaluating allergy history. Of the respondents, 86% were unaware of the association between metal hypersensitivity and poor patient outcomes. After presented with the evidence, 81% indicated they were likely or very likely to incorporate the evidence into their clinical practice. Common themes about barriers to implementing were 'Standards of Practice', 'Knowledge' and 'Futility of Screening'. CONCLUSION The findings suggest lack of awareness as the main reason for not including metal in routine allergy assessment.
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Affiliation(s)
- Dzifa Dordunoo
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Michelle Hass
- Center for Learning and Innovation, Scripps Health, San Diego, California, USA
| | - Catherine Smith
- Faculty of Health Studies, University of the Fraser Valley, Abbotsford, British Columbia, Canada
| | | | - Miriam Weinzierl
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | | | - Ajijoon Shaik
- Nursing Department, School of Health and Human Services, Camosun College, Victoria, British Columbia, Canada
| | - Anastasia Mallidou
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Farzad Adib
- Department of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
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Knappe UJ, Reinecke D, Flörke M, Horn P, Schönmayr R. Facet Joint Replacement: Intermediate- and Long-Term Outcome in a Large Case Series. J Neurol Surg A Cent Eur Neurosurg 2020; 82:34-42. [PMID: 33278826 DOI: 10.1055/s-0040-1716534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The long-term outcome of facet joint replacement (FJR) still is to be proven. METHODS We present a prospective case series of 26 (male-to-female ratio of 1:1; mean age: 61 years) patients undergoing FJR with a follow-up of at least 1 year (range: 12-112; mean: 67 months). Visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and the 12-Item Short Form Health Survey (SF-12) were applied pre- and postoperatively (after 3, 6, and 12 months) as well as at the last follow-up (N = 24). Using X-rays of the lumbar spine (N = 20), the range of motion (ROM) and disk height in the indicator and adjacent levels were assessed. RESULTS FJR was performed at L3/L4 (N = 7), L4/L5 (N = 17), and L5/S1 (N = 2). Mean VAS (mm) for back pain decreased from 71 to 18, mean VAS for right leg pain from 61 to 7, and from 51 to 3 for the left leg. Mean ODI dropped from 51 to 22% (for all p < 0.01). Eighty seven percent of patients were satisfied and pretreatment activities were completely regained in 78.3% of patients. Disk height at the indicator and adjacent levels and ROM at the indicator segment and the entire lumbar spine were preserved. No loosening of implants was observed. Explantation of FJR and subsequent fusion had to be performed in four cases (15.4%). CONCLUSIONS In selected cases, long-term results of FJR show good outcome concerning pain, quality of life, preservation of lumbar spine motion, and protection of adjacent level.
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Affiliation(s)
- Ulrich J Knappe
- Department of Neurosurgery, Johannes Wesling Hospital, Ruhr-University Bochum, Minden, Germany
| | - David Reinecke
- Department of Neurosurgery, Johannes Wesling Hospital, Ruhr-University Bochum, Minden, Germany
| | - Michael Flörke
- Department of Neurosurgery, Johannes Wesling Hospital, Ruhr-University Bochum, Minden, Germany
| | - Peter Horn
- Department of Neurosurgery, Helios Dr. Horst Schmidt Hospital, Wiesbaden, Germany
| | - Robert Schönmayr
- Department of Neurosurgery, Helios Dr. Horst Schmidt Hospital, Wiesbaden, Germany
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Kim J. A rare case of delayed hypersensitivity reaction to metal ions secondary to a remnant pedicle screw fragment after spinal arthrodesis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:461-464. [PMID: 32554366 DOI: 10.5152/j.aott.2020.20148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Delayed hypersensitivity reaction to metal ions is rare and has been mostly documented among patients undergoing total joint arthroplasty with metal-on-metal bearing surfaces. Nonetheless, to our knowledge, only a few cases associated with spinal arthrodesis have been reported in the literature. The aim of this case report was to describe the clinical features of a rare case of delayed-type hypersensitivity reaction to nickel that occurred after an extraordinarily long period of time (approximately 15 years) after spinal arthrodesis. Here, we present a 38-year-old patient who was referred to us with a diagnosis of delayed-type hypersensitivity reaction to nickel that was established by a skin patch test. The chief sign and symptoms of the patient were allergic contact dermatitis along with intractable, generalized itching that started several months ago. The medical history revealed that the patient had undergone spinal arthrodesis using rods and pedicle screws approximately 15 years ago, followed by revision surgery to remove the implants. Radiological examination showed a remnant pedicle screw fragment at the third lumbar vertebra that had broken off during the removal of implants nine years ago. However, the signs and symptoms of metal hypersensitivity started shortly before the patient was referred to our hospital. We decided to remove the screw fragment as allergic contact dermatitis was refractory to medical treatment. On postoperative day one, the itching was completely resolved, although the skin patch test remained positive.
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Affiliation(s)
- Jiha Kim
- Department of Neurosurgery, Kangwon National University, School of Medicine, Kangwon National University Hospital, Chuncheon-Si, Gangwon-Do, South Korea
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Metal Hypersensitivity After Spinal Instrumentation: When to Suspect and How to Treat. World Neurosurg 2020; 139:471-477. [DOI: 10.1016/j.wneu.2020.04.093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 11/18/2022]
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