Aseptic Loosening of Pedicle Screw As a Result of Metal Wear Debris in a Pediatric Patient

Botolin, Sergiu; Merritt, Conor; Erickson, Mark

doi:10.1097/brs.0b013e3182793e51

Cited by 30 publications

(21 citation statements)

References 16 publications

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“…Stress shielding, decreasing the load transferred through the bony tissue, resulting in remodeling of the bone surrounding the screw, was reported as another major reason for screw loosening . Additionally, the presence of wear debris was reported to induce osteolysis and consequent screw loosening . Of the mechanisms, microfracture and bone resorption triggered by excessive stress of the surrounding bone are the most common.…”

mentioning

confidence: 99%

Bone resorption triggered by high radial stress: The mechanism of screw loosening in plate fixation of long bone fractures

Feng

Lin

Fang

et al. 2019

Journal Orthopaedic Research

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Screw loosening is a common complication in plate fixation. However, the underlying mechanism is unclear. This study investigated screw loosening mechanisms by finite element analysis (FEA) simulation and clinical X‐ray feature analysis. Two FEA models incorporated bone heterogeneity and orthotropy, representing fracture fixation using dynamic compression plate (DCP) and locking compression plate (LCP), were developed. These models were used to examine the volume of bone exceeding a certain stress value around each screw under physiologically‐relevant loading conditions. These damaged bone was then separated and compared by the axial stress and radial stress of each screw. In addition, features of patients’ X‐ray images showing screw loosening were analyzed to validate the loosening features simulated by the models. The FEA study showed that more damaged bone was found at the central two screws which gradually decreased toward the two end screws in all groups. More bone was damaged by the radial stress of each screw than by the axial stress. The radiological analysis of screw loosening showed that bone loss occurred at the screw closest to the fracture line first then subsequent bone loss at the screws further away from the fracture line occurred. This study found that the two screws nearest to the fracture line are more vulnerable to loosening. The radial stress of the screw plays a larger role in screw loosening than the axial stress. Bone resorption triggered by the high radial stress of screws is indicated as the mechanism of screw loosening in the diaphyseal plate fixation. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1498–1507, 2019.

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confidence: 99%

Bone resorption triggered by high radial stress: The mechanism of screw loosening in plate fixation of long bone fractures

Feng

Lin

Fang

et al. 2019

Journal Orthopaedic Research

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“…Richman et al [9] recently reported a case of a 19-year-old male who presented with sudden onset of a neurologic deficit and pain 4 years after posterior spinal fusion for adolescent idiopathic scoliosis. A review of several cases of spinal metallosis after spinal fusion showed that most incidents involved invasion of the spinal canal leading to neural compression (except for one case reported by Botulin et al [10] as persistent back pain).…”

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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“…Late neurological complications, occurring years after successful spinal instrumentation, have rarely been reported in the literature [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Although some authors suggest that neurological symptoms appear due to the formation of epidural metallosis adjoining the hook-rod construct, the cause of the new-onset pain in our cases was related to direct compression of the canal by dislodged laminar hooks in the thoracolumbar region [1,11].…”

Section: Introductionmentioning

confidence: 86%

Late neurological complications due to laminar hook compression in idiopathic scoliosis surgery

Ferrando

Bas

2017

Spinal Cord Ser Cases

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In all three cases, the neurological symptoms were due to direct laminar hook compression. Metallosis was observed extra-spinally around the hook-rod construct but not at the sublaminar site. The dislodged laminar hook responsible for the symptoms was situated at the concavity of the curve with the blade-tip pointing downwards. Symptomatic improvement was observed in all patients following complete hardware removal. Conscientious long-term follow-up of patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is important in order to recognize late neurological deficits directly related to instrumentation. Anamnesis and physical examination are key for initial assessment and diagnosis, while myelography and computed tomography (CT) images are of great help to confirm the site of spinal compression. Removal of the dislodged laminar hooks after PSF with TSRH instrumentation in AIS cases can potentially improve neurological symptoms.

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Aseptic Loosening of Pedicle Screw As a Result of Metal Wear Debris in a Pediatric Patient

Cited by 30 publications

References 16 publications

Bone resorption triggered by high radial stress: The mechanism of screw loosening in plate fixation of long bone fractures

Bone resorption triggered by high radial stress: The mechanism of screw loosening in plate fixation of long bone fractures

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

Late neurological complications due to laminar hook compression in idiopathic scoliosis surgery

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