Delayed hypersensitivity reaction after cervical disc replacement: A case report

Lagier, Marion; Brière, M.; Giorgi, H; Fuentès, S.; Blondel, Benjamin; Tropiano, Patrick

doi:10.1016/j.otsr.2015.05.005

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…This concern has primarily stemmed from reports of wear debris associated with MoM hip prostheses 5,17 as well as several cases reporting reactions to MoM TDRs. 2,9,14,16 In response to the controversy generated from wear debris related to MoM hip implants, the Medicines and Healthcare products Regulatory Agency released a device alert issuing threshold serum values for cobalt and chromium at which hip replacement patients merit ongoing monitoring. Recently, Van Der Straeten et al evaluated cobalt and chromium levels related to a reduced clinical outcome following hip replacement surgery.…”

Section: Discussionmentioning

confidence: 99%

Prospective, randomized multicenter study of cervical arthroplasty versus anterior cervical discectomy and fusion: 5-year results with a metal-on-metal artificial disc

Coric

Guyer

Nunley

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVESeven cervical total disc replacement (TDR) devices have received FDA approval since 2006. These devices represent a heterogeneous assortment of implants made from various biomaterials with different biomechanical properties. The majority of these devices are composed of metallic endplates with a polymer core. In this prospective, randomized multicenter study, the authors evaluate the safety and efficacy of a metal-on-metal (MoM) TDR (Kineflex|C) versus anterior cervical discectomy and fusion (ACDF) in the treatment of single-level spondylosis with radiculopathy through a long-term (5-year) follow-up.METHODSAn FDA-regulated investigational device exemption (IDE) pivotal trial was conducted at 21 centers across the United States. Standard validated outcome measures including the Neck Disability Index (NDI) and visual analog scale (VAS) for assessing pain were used. Patients were randomized to undergo TDR using the Kineflex|C cervical artificial disc or anterior cervical fusion using structural allograft and an anterior plate. Patients were evaluated preoperatively and at 6 weeks and 3, 6, 12, 24, 36, 48, and 60 months after surgery. Serum ion analysis was performed on a subset of patients randomized to receive the MoM TDR.RESULTSA total of 269 patients were enrolled and randomly assigned to undergo either TDR (136 patients) or ACDF (133 patients). There were no significant differences between the TDR and ACDF groups in terms of operative time, blood loss, or length of hospital stay. In both groups, the mean NDI scores improved significantly by 6 weeks after surgery and remained significantly improved throughout the 60-month follow-up (both p < 0.01). Similarly, VAS pain scores improved significantly by 6 weeks and remained significantly improved through the 60-month follow-up (both p < 0.01). There were no significant changes in outcomes between the 24- and 60-month follow-ups in either group. Range of motion in the TDR group decreased at 3 months but was significantly greater than the preoperative mean value at the 12- and 24-month follow-ups and remained significantly improved through the 60-month period. There were no significant differences between the 2 groups in terms of reoperation/revision surgery or device-/surgery-related adverse events. The serum ion analysis revealed cobalt and chromium levels significantly lower than the levels that merit monitoring.CONCLUSIONSCervical TDR with an MoM device is safe and efficacious at the 5-year follow-up. These results from a prospective randomized study support that Kineflex|C TDR as a viable alternative to ACDF in appropriately selected patients with cervical radiculopathy.Clinical trial registration no.: NCT00374413 (clinicaltrials.gov)

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Section: Discussionmentioning

confidence: 99%

Prospective, randomized multicenter study of cervical arthroplasty versus anterior cervical discectomy and fusion: 5-year results with a metal-on-metal artificial disc

Coric

Guyer

Nunley

et al. 2018

Journal of Neurosurgery: Spine

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“…Post-spinal-implant metal allergy is a rare entity despite the high frequency of spinal implant reactions. Very few case reports of clinical spinal implant allergy have been published [3][4][5][6][7][8]. Chronic pain at the surgical site was reported in one case in the cervical region, and three thoracolumbar cases have also been reported.…”

Section: Discussionmentioning

confidence: 99%

“…In a study by Kitagawa et al involving 925 patients who underwent allergy patch testing for a clinical history of metal allergies, dental metal allergies were recognized as the major cause of their metal allergies, and symptoms appeared in 392 of the 925 (42.4%) patients [2]. There have also been a few case reports of metal allergies after spinal instrumentation surgeries [3][4][5][6][7][8]. Furthermore, allergies, though fewer in number, have been reported after titanium alloy implants [1,[6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Cervical Implant Allergy With Chronic Neck Pain: A Case Report

Aoyama¹,

Anazawa²,

Hotta³

et al. 2022

Cureus

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A 57-year-old woman underwent cervical implant surgery for a dislocated cervical spine fracture, and she complained of continuous intractable neck pain after surgery. Eight years later, she developed a plantar skin rash, subsequently diagnosed as a metal allergy, and metal dentures were replaced with ceramic ones. The skin rash, however, persisted for four more years after that and was eventually treated with cervical implant removal. Subsequently, her skin rash and her neck pain improved simultaneously. This synchronous improvement strongly suggested that the neck pain could have been caused by a cervical implant allergy. We discuss a case of posterior cervical implant allergy that presented with neck pain and plantar skin rash years after surgery.

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“…Of the 15 case reports of allergy to spinal implants, the majority (87%) were due to disc arthroplasty (most commonly containing cobalt and chromium), with only two cases of pedicle screw instrumentation [Table 2]. [1][2][3]5,6,8,[10][11][12]14,15] Notably, allergies attributed to disc replacements are likely due to corrosion and wear debris occurring secondary to load-bearing stress, increasing the risk for corrosion. [7] Testing for metal allergy Patients with hypersensitivity reactions may be difficult to differentiate from the much more common wound infection complications.…”

Section: Discussionmentioning

confidence: 99%

Metal allergy hypersensitivity after posterior thoracic spinal fusion: A case report and review of the literature

Saini

Wang

Kosarchuk

et al. 2021

Surgical Neurology International

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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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Delayed hypersensitivity reaction after cervical disc replacement: A case report

Cited by 5 publications

References 11 publications

Prospective, randomized multicenter study of cervical arthroplasty versus anterior cervical discectomy and fusion: 5-year results with a metal-on-metal artificial disc

Prospective, randomized multicenter study of cervical arthroplasty versus anterior cervical discectomy and fusion: 5-year results with a metal-on-metal artificial disc

Cervical Implant Allergy With Chronic Neck Pain: A Case Report

Metal allergy hypersensitivity after posterior thoracic spinal fusion: A case report and review of the literature

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