Corrosion of Harrington rod in idiopathic scoliosis: long-term effects
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.
KeywordsScoliosis Spinal implants Corrosion Metal ions Metallosis
The author thanks Ashlee-Ann E. Pigford, M.Sc., who was very helpful in guiding me through the process of writing.
Compliance with ethical standards
Conflict of interest
None of the authors has any potential conflict of interest.
- 12.Caicedo MS, Desai R, McAllister K, Reddy A, Jacobs JJ, Hallab NJ (2009) Soluble and particulate Co–Cr–Mo alloy implant metals activate the inflammasome danger signaling pathway in human macrophages: a novel mechanism for implant debris reactivity. J Orthop Res 27:847–854. doi: 10.1002/jor.20826 CrossRefPubMedGoogle Scholar
- 13.Gristina AG (1994) Implant failure and the immune-incompetent fibro-inflammatory zone. Clin Orthop Relat Res 298:106–118Google Scholar
- 20.Yanese M, Sakou T, Taketomi E, Yone K (1995) Transpedicular fixation of the lumbar and lumbosacral spine with screws. Application of the Diapason system. Paraplegia 33:216–218Google Scholar
- 37.Cundy TP, Cundy WJ, Antoniou G, Sutherland LM, Freeman BJC, Cundy PJ (2014) Serum titanium, niobium, and aluminum levels two years following instrumented spinal fusion in children: does implant surface area predict serum metal ion levels? Eur Spine J 23:2393–2400. doi: 10.1007/s00586-014-3279-x CrossRefPubMedGoogle Scholar
- 40.Zeh A, Becker C, Planert M, Lattke P, Wohlrab D (2009) Time-dependent release of cobalt and chromium ions into the serum following implantation of the metal-on-metal Maverick type artificial lumbar disc. Arch Orthop Trauma Surg 129:741–746. doi: 10.1007/s00402-008-0677-8 CrossRefPubMedGoogle Scholar