Comparison of Different Surgical Systems for Treatment of Early-onset Scoliosis in the Context of Release of Titanium Ions

Abstract

Study Design. Case–control study. Objective. The aim of the study was to compare growth-friendly systems: traditional growing rod, guided growth systems (GGS), and vertical expandable prosthetic titanium rib in the context of titanium release. Summary of Background Data. The problem of scoliosis affects even up to 3% of the population, and ca. 0.1% of patients need surgical treatment. Surgical treatment carries the risk of a long-term presence of implants in the organism, which may result in release of metal ions into the tissues and bloodstream. Methods. Seventy-one patients (13.5 ± 3.54 years’ old) were treated for spinal deformity using various surgical systems and the samples of paraspinal tissue, blood, nails, and hair were collected before and after treatment. The quantification of titanium was performed using inductively coupled plasma optical emission spectrometry. Results. The metallic particles were released into the peri-implant tissue, and the greatest amounts of titanium were detected in patients with GGS. The concentration of soluble titanium forms in subcutaneous tissue (ST) was low and do not statistically differ from control. The average titanium content in the paraspinal tissue in patients with GGS was two- to three-fold higher than the average value in the other investigated groups. A slightly increased level of titanium compared with the control was noted in all studied groups of patients. The highest content of titanium in blood was observed in patients with the GGS system. Conclusion. Neverless the system used, the concentration of soluble titanium forms in both ST and blood was only slightly higher than in the control and did not exceed the allowable levels. The increased level of titanium with GGS system is probably associated with the friction between implant components, whereas the components in the other systems are immobile relative to each other. Level of Evidence: 3

Complications in growth-friendly spinal surgeries for early-onset scoliosis: Literature review

“…However, problems with the loss of fixation and failure of the implants in some cases persist[ 10 , 47 ]. Some authors have pointed out an additional problem connected with metal debris which appears in the serum and surrounding tissues[ 52 ]. Although it does not directly affect the outcome of the treatment, it is worth considering this occurrence as undesirable/a complication.…”

Subcutaneous Bupivacaine Infiltration Is Not Effective to Support Control of Postoperative Pain in Paediatric Patients Undergoing Spinal Surgery

“…They also carry the risk of many problems and complications [1,2]. The emerging surgical techniques and new implants have not yet brought about considerable change in the concept of the procedure, and the exposure of a substantial part of the spine is necessary, which certainly contributes to post-operative pain [3,4]. Effective pain management after posterior spinal fusion, in paediatric patients, is an essential part of surgical treatment for increasing patient's comfort, allowing quicker convalescence.…”

Serum Titanium Levels Remain Elevated But Urine Titanium is Undetectable in Children With Early Onset Scoliosis Undergoing Growth-Friendly Surgical Treatment: A Prospective Study

“…The primary composition of these implants is titanium, which has previously been recognized as an inert and biocompatible substance 4 . However, recent studies have demonstrated that titanium can be gradually released into local tissues from mechanical wear, such as friction and bending, in ionized and nanoparticle forms that are absorbed in the bloodstream and transported to other organ systems 5,6 . There have been a number of studies that have reported significant metallosis and wear debris in the soft tissues of patients with growth-friendly implants (GFI) 7–11 .…”

“…4 However, recent studies have demonstrated that titanium can be gradually released into local tissues from mechanical wear, such as friction and bending, in ionized and nanoparticle forms that are absorbed in the bloodstream and transported to other organ systems. 5,6 There have been a number of studies that have reported significant metallosis and wear debris in the soft tissues of patients with growth-friendly implants (GFI). [7][8][9][10][11] As a result of this local debris deposition, macrophages, and cytokines are recruited to the area, initiating an inflammatory response that can possibly lead to pseudoarthrosis, osteolysis, and late postoperative surgical site infection.…”