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Journal of Children's Orthopaedics

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Open Access 01-02-2015 | Original Clinical Article

Local and systemic metal ion release occurs intraoperatively during correction and instrumented spinal fusion for scoliosis

Authors: William J. Cundy, Annika R. Mascarenhas, Georgia Antoniou, Brian J. C. Freeman, Peter J. Cundy

Published in: Journal of Children's Orthopaedics | Issue 1/2015

Abstract

Study design

Prospective pilot study.

Objectives

The aim of this study was to measure titanium, niobium and aluminium levels in various intraoperative and postoperative samples to determine patterns of metal ion release that occur within the first month following instrumented spinal fusion.

Summary of background data

Raised serum metal ion levels are reported following instrumented spinal fusion in adolescent idiopathic scoliosis. The exact topological origin and chronology of metal ion release remains conjectural. Recent literature suggests an immediate rise in serum metal levels within the first postoperative week.

Methods

Titanium, niobium and aluminium levels were measured before, during and after surgery in serum and local intraoperative fluid samples obtained from two pediatric patients undergoing posterior correction and instrumentation for scoliosis.

Results

Measurable metal ion levels were detected in all local samples obtained from wound irrigation fluid, cell saver blood, and fluid that immersed metal universal reduction screw tabs. Postoperative serum metal ion levels were elevated compared to baseline preoperative levels. In general, metal ion levels were considerably higher in the intraoperative fluid samples compared to those observed in the serum levels.

Conclusion

Our findings of contextually high metal ion concentrations in intraoperative and early postoperative samples provide further empirical support of a ‘putting-in’ phenomenon of metal ion release following instrumented spinal fusion. This challenges existing beliefs that metal ion release occurs during an intermediate ‘wearing-in’ phase. We recommend thorough irrigation of the operative site prior to wound closure to dilute and remove intraoperative metal ion debris. Possibilities of filtering trace metal ions from cell saver content may be considered.

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Title: Local and systemic metal ion release occurs intraoperatively during correction and instrumented spinal fusion for scoliosis
Authors: William J. Cundy
Annika R. Mascarenhas
Georgia Antoniou
Brian J. C. Freeman
Peter J. Cundy
Publication date: 01-02-2015
Publisher: Springer Berlin Heidelberg
Published in: Journal of Children's Orthopaedics / Issue 1/2015
Print ISSN: 1863-2521
Electronic ISSN: 1863-2548
DOI: https://doi.org/10.1007/s11832-015-0631-6

At a glance: The STEP trials

Springer Medicine

Local and systemic metal ion release occurs intraoperatively during correction and instrumented spinal fusion for scoliosis

Abstract

Study design

Objectives

Summary of background data

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Study design

Objectives

Summary of background data

Methods

Results

Conclusion

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