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Metal Ion Release During Growth-Friendly Instrumentation for Early-Onset Scoliosis: A Preliminary Study

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Abstract

Background

Metal ions released from spinal instruments can cause localized debris and distribute systemically to settle on distant organs. Children with early-onset deformities live with metallic implants for a substantial amount of time. No research focused on metal distribution in growth-friendly instrumentations. The aim of this study was to compare age-matched growing rod (GR) and magnetically controlled growing rod (MCGR) groups to noninstrumented controls.

Methods

The study was designed as a multicenter, prospective, cross-sectional case series. GR and MCGR applications of three institutions were included. A total of 52 children were enrolled. Blood samples were collected between December 2014 and February 2015. Biochemical serum analyses were performed to trace and quantify titanium, vanadium, aluminum, and boron. The GR group included 15 children. Mean age was 10.7 (range 6–15). MCGR group included 22 children. Mean age was 8.5 (range 2–13). Fifteen age-matched nonoperated children formed the control group. The mean age was 10.4 (range 5–15). One-way analysis of variance, Kruskal-Wallis, and Mann-Whitney U tests were used for comparisons.

Results

The mean serum titanium level in control, GR, and MCGR groups were 2.8 ± 1.4, 7.3 ± 4.3, and 10.2 ± 6.8 μg/L, respectively. GR and MCGR group titanium levels were higher than controls’ (p = .008 and p < .001). The mean serum vanadium level in control, GR, and MCGR groups were 0.2 ± 0.0, 0.2 ± 0.0, and 0.5 ± 0.5 μg/L, respectively. MCGR group vanadium level was higher than control (p < .001) and GR groups (p = .004). Mean serum levels in control, GR, and MCGR groups were, respectively, 5.4 ± 4.1, 8.1 ± 7.4, and 7.8 ± 5.1 μg/L for aluminum and 86.7 ± 2.7, 86.9 ± 2.5, and 85.0 ± 6.6 μg/L for boron. The distribution of aluminum and boron were similar across groups (p = .675 and p = .396).

Conclusions

Both GR and MCGR applications significantly release titanium and possibly aluminum. MCGR further releases vanadium. MCGR possibly releases more titanium than traditional GR. Time-dependent alterations of serum ion levels, structural properties of the MCGR device, and exposure caused by magnetic distraction processes warrant investigation.

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References

  1. Wang JC, Yu WD, Sandhu HS, et al. Metal debris from titanium spinal implants. Spine 1999;24:899–903.

    Article  CAS  Google Scholar 

  2. McPhee IB, Swanson CE. Metal ion levels in patients with stainless steel spinal instrumentation. Spine 2007;32:1963–8.

    Article  Google Scholar 

  3. Yazici M, Olgun ZD. Growing rod concepts: state of the art. Eur Spine J 2013;22(Suppl 2):S118–30.

    Article  Google Scholar 

  4. Akbarnia BA, Campbell RM, Dimeglio A, et al. Fusionless procedures for the management of early-onset spine deformities in 2011: what do we know? J Child Orthop 2011;5:159–72.

    Article  Google Scholar 

  5. Cundy TP, Antoniou G, Sutherland LM, et al. Serum titanium, niobium, and aluminum levels after instrumented spinal arthrodesis in children. Spine 2013;38:564–70.

    Article  Google Scholar 

  6. Cundy WJ, Mascarenhas AR, Antoniou G, et al. Local and systemic metal ion release occurs intraoperatively during correction and instrumented spinal fusion for scoliosis. J Child Orthop 2015;9:39–43.

    Article  Google Scholar 

  7. Kim YJ, Kassab F, Berven SH, et al. Serum levels of nickel and chromium after instrumented posterior spinal arthrodesis. Spine 2005;30:923–6.

    Article  Google Scholar 

  8. Richardson TD, Pineda SJ, Strenge KB, et al. Serum titanium levels after instrumented spinal arthrodesis. Spine 2008;33:792–6.

    Article  Google Scholar 

  9. Savarino L, Greggi T, Martikos K, et al. Long-term systemic metal distribution in patients with stainless steel spinal instrumentation: a case-control study. J Spinal Disord Tech 2015;28:114–8.

    Article  Google Scholar 

  10. Savarino L, Granchi D, Ciapetti G, et al. Ion release in patients with metal-on-metal hip bearings in total joint replacement: a comparison with metal-on-polyethylene bearings. J Biomed Mater Res 2002;63:467–74.

    Article  CAS  Google Scholar 

  11. Engh Jr CA, MacDonald SJ, Sritulanondha S, et al. 2008 John Charnley award: metal ion levels after metal-on-metal total hip arthroplasty: a randomized trial. Clin Orthop Relat Res 2009;467:101–11.

    Article  Google Scholar 

  12. Engh CA, MacDonald SJ, Sritulanondha S, et al. Metal ion levels after metal-on-metal total hip arthroplasty: a five-year, prospective randomized trial. J Bone Joint Surg Am 2014;96:448–55.

    Article  CAS  Google Scholar 

  13. Agarwal A, Agarwal AK, Jayaswal A, et al. Outcomes of optimal distraction forces and frequencies in growth rod surgery for different types of scoliotic curves: an in silico and in vitro study. Spine Deform 2017;5:18–26.

    Article  Google Scholar 

  14. Galvis S, Arnold J, Mannen E, et al. Biomechanical evaluation of a growth-friendly rod construct. Spine Deform 2017;5:11–7.

    Article  Google Scholar 

  15. Fortoul TI, Quan-Torres A, Sánchez I, et al. Vanadium in ambient air: concentrations in lung tissue from autopsies of Mexico City residents in the 1960s and 1990s. Arch Environ Health 2002;57:446–9.

    Article  CAS  Google Scholar 

  16. Panichev N, Mandiwana K, Moema D, et al. Distribution of vanadium(V) species between soil and plants in the vicinity of vanadium mine. J Hazard Mater 2006;137:649–53.

    Article  CAS  Google Scholar 

  17. Olness A, Gesch R, Forcella F, et al. Importance of vanadium and nutrient ionic ratios on the development of hydroponically grown cuphea. Ind Crops Prod 2005;21:165–71.

    Article  CAS  Google Scholar 

  18. Ellingsen DG, Chashchin M, Berlinger B, et al. Biological monitoring of welders’ exposure to chromium, molybdenum, tungsten and vanadium. J Trace Elem Med Biol 2017;41:99–106.

    Article  CAS  Google Scholar 

  19. Teoh KH, von Ruhland C, Evans SL, et al. Metallosis following implantation of magnetically controlled growing rods in the treatment of scoliosis: a case series. Bone Joint J 2016;98:1662–7.

    Article  Google Scholar 

  20. McCarthy RE, McCullough FL. Shilla growth guidance for early-onset scoliosis: results after a minimum of five years of follow-up. J Bone Joint Surg Am 2015;97:1578–84.

    Article  Google Scholar 

  21. Lukina E, Laka A, Kollerov M, et al. Metal concentrations in the blood and tissues after implantation of titanium growth guidance sliding instrumentation. Spine J 2016;16:380–8.

    Article  Google Scholar 

  22. Chen Z, Wang Z, Wang Q, et al. Changes in early serum metal ion levels and impact on liver, kidney, and immune markers following metal-on-metal total hip arthroplasty. J Arthroplasty 2014;29:612–6.

    Article  Google Scholar 

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Authors and Affiliations

  1. Orthopedics and Traumatology, Acibadem Mehmet Ali Aydınlar University, İçerenköy Mh. No:32 Kerem Aydınlar Kampüsü, Kayışdağı Cd., 34752, Ataşehir, Turkey

    Caglar Yilgor MD & Ahmet Alanay MD

  2. Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey

    Ayaz Efendiyev MD, Gokhan Demirkiran MD & Muharrem Yazici MD

  3. Medical Biochemistry, Hacettepe University, 06100, Sihhiye, Ankara, Turkey

    Filiz Akbiyik MD

  4. Orthopedics and Traumatology, Gazi University, Emniyet Mahallesi, 06560, Yenimahalle, Ankara, Turkey

    Alpaslan Senkoylu MD

Authors
  1. Caglar Yilgor MD
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  2. Ayaz Efendiyev MD
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  3. Filiz Akbiyik MD
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  4. Gokhan Demirkiran MD
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  5. Alpaslan Senkoylu MD
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  6. Ahmet Alanay MD
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  7. Muharrem Yazici MD
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Corresponding author

Correspondence to Muharrem Yazici MD.

Additional information

IRB approval

This study was reviewed and approved by Hacettepe University Clinical Researches Ethics Board.

Author disclosures

CY (none); AE (none); FA (none); GD (none); AS (none); AA (personal fees from DePuy Synthes, personal fees from Stryker Spine, grants from DePuy Synthes, outside the submitted work); MY (personal fees from DePuy Synthes, outside the submitted work).

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Yilgor, C., Efendiyev, A., Akbiyik, F. et al. Metal Ion Release During Growth-Friendly Instrumentation for Early-Onset Scoliosis: A Preliminary Study. Spine Deform 6, 48–53 (2018). https://doi.org/10.1016/j.jspd.2017.06.005

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  • DOI: https://doi.org/10.1016/j.jspd.2017.06.005

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