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European Spine Journal

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01-11-2014 | Original Article

Serum titanium, niobium and aluminium levels two years following instrumented spinal fusion in children: does implant surface area predict serum metal ion levels?

Authors: Thomas P. Cundy, William J. Cundy, Georgia Antoniou, Leanne M. Sutherland, Brian J. C. Freeman, Peter J. Cundy

Published in: European Spine Journal | Issue 11/2014

Abstract

Purpose

Measurement of serum metal ion levels is used to determine systemic exposure to implant-derived metal debris that may be generated by processes of wear and corrosion. The aim of this study is to investigate predictors of serum metal ion levels in children undergoing instrumented spinal arthrodesis using a titanium alloy, focusing on implant characteristics and instrumentation construct design variables.

Methods

This prospective longitudinal cohort study involved 33 children. Serum samples were obtained pre-operatively and at five defined interval periods over the first two post-operative years. Samples were analysed using high-resolution inductively coupled plasma mass spectrometry to measure titanium, niobium and aluminium concentrations. Instrumentation characteristics were catalogued and construct surface area (SA) measurements calculated using an implant-specific software algorithm tool.

Results

Significantly elevated levels of serum titanium and niobium were observed (p < 0.0001), with >95 % of post-operative levels abnormally elevated. Significant predictors of serum titanium and niobium levels included time since surgery, surgical procedure (posterior or anterior fusion), number of levels fused, number of pedicle screws inserted, total rod length, total metal SA, total exposed metal SA and total metal-on-metal SA. All significant instrumentation variables were highly correlated.

Conclusions

There is a strong relationship between implant SA and both serum titanium and niobium levels. The direct clinical implications of these findings for patients are uncertain, but remain of concern. Surgeons should be aware of the strong correlation between implant surface area of the chosen construct and the subsequent serum metal ion levels.

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Title: Serum titanium, niobium and aluminium levels two years following instrumented spinal fusion in children: does implant surface area predict serum metal ion levels?
Authors: Thomas P. Cundy
William J. Cundy
Georgia Antoniou
Leanne M. Sutherland
Brian J. C. Freeman
Peter J. Cundy
Publication date: 01-11-2014
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 11/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-014-3279-x

At a glance: The STEP trials

Springer Medicine

Serum titanium, niobium and aluminium levels two years following instrumented spinal fusion in children: does implant surface area predict serum metal ion levels?

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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