Intraspinal metalloma resulting in late paraparesis

Tezer, Mehmet; Kuzgun, Unal; Hamzaoğlu, Azmi; Öztürk, Çağatay; Kabukçuoğlu, Fevziye; Şirvancı, Mustafa

doi:10.1007/s00402-005-0802-x

Cited by 39 publications

(35 citation statements)

References 32 publications

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“…2 A metal in living tissue is prone to corrosion due to electrochemical reactions. 4 In addition to the wellinvestigated electrochemical aspect of corrosion in a physiological system, this study demonstrates that human OC grow as well on SS as they grow on glass, and are able to directly corrode the metal surface and subsequently release metal ions. Furthermore, these results indicate that the released metal ions may cause inflammatory reactions by inducing the secretion of proinflammatory cytokines IL-1b, IL-6, and TNF-a, which in Figure 3.…”

Section: Discussionmentioning

confidence: 70%

“…1 However, their permanent tendency to corrode when exposed to a physiological environment remains a serious concern. [2][3][4] Elevated concentrations of metal ions have been measured in clinically retrieved peri-prosthetic tissues, distal organs, and body fluids in total hip arthroplasty patients. [5][6][7] The biology behind corrosion inside the human body and the distribution of the metal ions throughout the organism is not fully understood.…”

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confidence: 99%

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Bio‐corrosion of stainless steel by osteoclasts—in vitro evidence

Cadosch

Chan

Gautschi

et al. 2008

Journal Orthopaedic Research

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Most metals in contact with biological systems undergo corrosion by an electrochemical process. This study investigated whether human osteoclasts (OC) are able to grow on stainless steel (SS) and directly corrode the metal alloy leading to the formation of corresponding metal ions, which may cause inflammatory reactions and activate the immune system. Scanning electron microscopy analysis demonstrated long-term viable OC cultures and evident resorption features on the surface of SS discs on which OC were cultured for 21 days. The findings were confirmed by atomic emission spectrometry investigations showing significantly increased levels of chromium, nickel, and manganese in the supernatant of OC cultures. Furthermore, significant levels of pro-inflammatory cytokines IL-1b, IL-6, and TNF-a, which are considered to be major mediators of osteolysis, were revealed in the same cultures by cytometric bead array analysis. Within the present study, it was shown that human osteoclast precursors are able to grow and differentiate towards mature OC on SS. The mature cells are able to directly corrode the metal surface and release corresponding metal ions, which induce the secretion of pro-inflammatory cytokines that are known to enhance osteoclast differentiation, activation, and survival. Enhanced corrosion and the subsequently released metal ions may therefore result in enhanced osteolytic lesions in the peri-prosthetic bone, contributing to the aseptic loosening of the implant. Keywords: osteoclast; bio-corrosion; stainless steel; osteolysis; TNF-a Over the last decades, significant developments have been taking place to provide suitable metal alloys for implants with optimal mechanical characteristics and good biocompatibility with minimal adverse host tissue reactions. 1 However, their permanent tendency to corrode when exposed to a physiological environment remains a serious concern. 2-4 Elevated concentrations of metal ions have been measured in clinically retrieved peri-prosthetic tissues, distal organs, and body fluids in total hip arthroplasty patients. [5][6][7] The biology behind corrosion inside the human body and the distribution of the metal ions throughout the organism is not fully understood. It has been suggested that extracellular body fluids have corrosive proprieties and contain metal binding proteins. 2,3 Furthermore, it has been debated whether osteoclasts (OC) are able to corrode pure metal when entering into contact with metal surfaces. However, direct evidence of metal corrosion by OC has been missing to date.Osteoclasts are highly specialized multinucleated cells, which are capable of bone resorption. They are formed by the fusion of marrow-derived mononuclear precursors, which circulate in the peripheral blood. Osteoclastic differentiation from hematopoietic and circulating monocytes occurs in the presence of macrophage-colony stimulating factor (M-CSF) and the receptor activator of NF-kB ligand (RANK-L) which are expressed on osteoblastic cells. 8 Mature OC display distinct morpholog...

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Section: Discussionmentioning

confidence: 70%

mentioning

confidence: 99%

Bio‐corrosion of stainless steel by osteoclasts—in vitro evidence

Cadosch

Chan

Gautschi

et al. 2008

Journal Orthopaedic Research

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“…But with other types of implants this is not observed. Looking at the cases reported by Tezer [26] and Takahashi [25], with neurological symptoms in relation to corrosion, no radiological signs of corrosion are seen in plain radiographies. It is possible that for other kinds of instrumentations, like CD or TSRH, in which corrosion has been reported in the literature, metal levels can be more useful than looking for radiographic signs of corrosion.…”

Section: Discussionmentioning

confidence: 90%

“…Also, specific localization of the corrosion site may determine other complications. In spinal implants, Tezer et al [26] and Takahashi et al [25] have reported delayed neurological symptoms caused by intraspinal metallosis, including radiculopathy and paraparesis.…”

Section: Introductionmentioning

confidence: 99%

Metal levels in corrosion of spinal implants

Rı́o¹,

Beguiristáin²,

Duart³

2007

Eur Spine J

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Corrosion affects spinal instrumentations and may cause local and systemic complications. Diagnosis of corrosion is difficult, and nowadays it is performed almost exclusively by the examination of retrieved instrumentations. We conducted this study to determine whether it is possible to detect corrosion by measuring metal levels on patients with posterior instrumented spinal fusion. Eleven asymptomatic patients, with radiological signs of corrosion of their stainless steel spinal instrumentations, were studied by performing determinations of nickel and chromium in serum and urine. Those levels were compared with the levels of 22 patients with the same kind of instrumentation but without evidence of corrosion and to a control group of 22 volunteers without any metallic implants. Statistical analysis of our results revealed that the patients with spinal implants without radiological signs of corrosion have increased levels of chromium in serum and urine (P < 0.001) compared to volunteers without implants. Corrosion significantly raised metal levels, including nickel and chromium in serum and urine when compared to patients with no radiological signs of corrosion and to volunteers without metallic implants (P < 0.001). Metal levels measured in serum have high sensibility and specificity (area under the ROC curve of 0.981). By combining the levels of nickel and chromium in serum we were able to identify all the cases of corrosion in our series of patients. The results of our study confirm that metal levels in serum and urine are useful in the diagnosis of corrosion of spinal implants and may be helpful in defining the role of corrosion in recently described clinical entities such as late operative site pain or late infection of spinal implants.

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“…The first intraspinal metallosis causing delayed neurologic symptoms after spinal instrumentation was reported by Takahashi et al [6]. Intraspinal metalloma resulting in late paraparesis was also reported by Tezer et al [7]. A case of intraspinal metallosis adjacent to the pedicular hook, which developed after thoracic vertebral fracture treatment, caused paraparesis at the 3rd postoperative year.…”

Section: Discussionmentioning

confidence: 89%

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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Intraspinal metalloma resulting in late paraparesis

Cited by 39 publications

References 32 publications

Bio‐corrosion of stainless steel by osteoclasts—in vitro evidence

Bio‐corrosion of stainless steel by osteoclasts—in vitro evidence

Metal levels in corrosion of spinal implants

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

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