Department of Neurosurgery, Lille University Hospital, France.
J Neurosurg Spine. 2013 Sep;19(3):389-91. doi: 10.3171/2013.6.SPINE121010. Epub 2013 Jul 5.
The authors report the case of a 53-year-old woman who underwent placement of a metal-on-metal total disc replacement (TDR) device for the treatment of discogenic back pain. The initial postoperative course was normal, but 2 months after surgery she started to complain of a recurrence of pain and she progressively developed cauda equina syndrome. Radiological and biological findings showed an inflammatory polyneuropathy associated with an epidural mass. A diagnosis of cell-mediated hypersensitivity reaction (Type IV) was made after patch testing showed positive reactions for 1% cobalt chloride and chromium. A decision was made to remove the TDR device and to perform a circumferential fusion. This report is intended to inform the reader that systemic metal release and hypersensitivity reaction are possible complications of metal-on-metal TDR.
作者报告了一例 53 岁女性的病例，该患者因椎间盘源性腰痛接受了金属对金属全椎间盘置换（TDR）装置的植入。术后初期恢复正常，但在术后 2 个月时，她开始抱怨疼痛复发，并逐渐出现马尾综合征。影像学和生物学检查结果显示与硬膜外肿块相关的炎症性多发性神经病。斑贴试验显示 1%氯化钴和铬阳性反应后，诊断为细胞介导的超敏反应（IV 型）。决定取出 TDR 装置并进行环周融合。本报告旨在告知读者，全身性金属释放和超敏反应是金属对金属 TDR 的可能并发症。
