Sherman Beth, Crowell Tanya
, Suite 709, 5 Northtown Way, Toronto, ON, M2N 7A1, Canada.
, 11754 County Rd. 29, Roseneath, ON, K0K 2X0, Canada.
Eur Spine J. 2018 Jul;27(Suppl 3):298-302. doi: 10.1007/s00586-017-5183-7. Epub 2017 Jun 17.
Metal implants have been used to treat adolescent idiopathic scoliosis since the 1960s. Only recently, however, it has the issue of metal-bone breakdown secondary to metal corrosion in situ come to light, raising concerns of possible long-term complications from the resulting metallosis and inflammation of spinal tissues. We present a case of a patient with neurological deficit, pain, and disability with Harrington rod in place for over 30 years, to bring attention to the issue of bio-corrosion of metal implants and its effect on human tissue. We call attention to the need for protocols to better diagnose and treat these patients.
We provide a complete review of the history and clinical manifestations as well as serum metal, X-ray, and CT/myelogram test results.
A 52-year-old female with spinal fusion and Harrington rod presents with pain, lymphedema, disability, and neurological deficits including thoracic outlet syndrome, hyperreflexia, peripheral muscle weakness and atrophy, hypertonicity, Raynaud's phenomenon, and balance and gait abnormalities. Serum chromium levels were elevated (26.73 nmol). X-rays showed no evidence of rod breakdown. Serial X-rays can demonstrate subtle corrosive changes but were not available. Adhesive arachnoiditis was diagnosed via CT/myelogram.
We hypothesize that bio-corrosion is present in this case and that it is associated with intraspinal metallosis. Trauma secondary to a motor vehicle accident, as well as arachnoiditis, and their possible effects on this case are outlined. Challenges in proper diagnosis and management are discussed.
自20世纪60年代以来，金属植入物一直被用于治疗青少年特发性脊柱侧凸。然而，直到最近，金属原位腐蚀继发的金属-骨破坏问题才被发现，这引发了人们对由此产生的金属沉着病和脊柱组织炎症可能导致的长期并发症的担忧。我们报告一例患者，其使用哈灵顿棒超过30年，出现神经功能缺损、疼痛和残疾，以引起人们对金属植入物生物腐蚀问题及其对人体组织影响的关注。我们呼吁制定相关方案，以更好地诊断和治疗这些患者。
我们全面回顾了病史、临床表现以及血清金属、X线和CT/脊髓造影检查结果。
一名52岁女性，接受了脊柱融合术并植入哈灵顿棒，出现疼痛、淋巴水肿、残疾和神经功能缺损，包括胸廓出口综合征、反射亢进、周围肌肉无力和萎缩、张力亢进、雷诺现象以及平衡和步态异常。血清铬水平升高（26.73纳摩尔）。X线检查未发现棒材断裂迹象。连续X线检查可显示细微的腐蚀变化，但未进行此项检查。通过CT/脊髓造影诊断为粘连性蛛网膜炎。
我们推测该病例存在生物腐蚀，且与椎管内金属沉着病有关。概述了机动车事故继发的创伤以及蛛网膜炎及其对此病例可能产生的影响。讨论了正确诊断和管理方面的挑战。
