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Serum titanium, niobium and aluminium levels two years following instrumented spinal fusion in children: does implant surface area predict serum metal ion levels?

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Abstract

Purpose

Measurement of serum metal ion levels is used to determine systemic exposure to implant-derived metal debris that may be generated by processes of wear and corrosion. The aim of this study is to investigate predictors of serum metal ion levels in children undergoing instrumented spinal arthrodesis using a titanium alloy, focusing on implant characteristics and instrumentation construct design variables.

Methods

This prospective longitudinal cohort study involved 33 children. Serum samples were obtained pre-operatively and at five defined interval periods over the first two post-operative years. Samples were analysed using high-resolution inductively coupled plasma mass spectrometry to measure titanium, niobium and aluminium concentrations. Instrumentation characteristics were catalogued and construct surface area (SA) measurements calculated using an implant-specific software algorithm tool.

Results

Significantly elevated levels of serum titanium and niobium were observed (p < 0.0001), with >95 % of post-operative levels abnormally elevated. Significant predictors of serum titanium and niobium levels included time since surgery, surgical procedure (posterior or anterior fusion), number of levels fused, number of pedicle screws inserted, total rod length, total metal SA, total exposed metal SA and total metal-on-metal SA. All significant instrumentation variables were highly correlated.

Conclusions

There is a strong relationship between implant SA and both serum titanium and niobium levels. The direct clinical implications of these findings for patients are uncertain, but remain of concern. Surgeons should be aware of the strong correlation between implant surface area of the chosen construct and the subsequent serum metal ion levels.

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Acknowledgments

Non-commercial funds were received for this study from the Bone Growth Foundation Inc, Women’s and Children’s Hospital Foundation and Florey Medical Research Fund. The authors wish to acknowledge the contribution of Dr. Peter Kalt (Department of Mechanical Engineering, The University of Adelaide, South Australia) and assistance of Dr. Peter Baghurst, Mrs Susan Barlow RN, Mrs Helena Penny RN, and the staff of SA Pathology Laboratory at the Women’s and Children’s Hospital.

Conflict of interest

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Women’s and Children’s Hospital (WCH), Adelaide, 72 King William Road, North Adelaide, SA, 5006, Australia

    Thomas P. Cundy, William J. Cundy, Georgia Antoniou, Leanne M. Sutherland, Brian J. C. Freeman & Peter J. Cundy

  2. Department of Spinal Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia

    Brian J. C. Freeman

  3. Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, Australia

    Brian J. C. Freeman & Peter J. Cundy

Authors
  1. Thomas P. Cundy
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  2. William J. Cundy
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  3. Georgia Antoniou
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  4. Leanne M. Sutherland
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  5. Brian J. C. Freeman
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  6. Peter J. Cundy
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Correspondence to Peter J. Cundy.

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Cundy, T.P., Cundy, W.J., Antoniou, G. et al. Serum titanium, niobium and aluminium levels two years following instrumented spinal fusion in children: does implant surface area predict serum metal ion levels?. Eur Spine J 23, 2393–2400 (2014). https://doi.org/10.1007/s00586-014-3279-x

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  • DOI: https://doi.org/10.1007/s00586-014-3279-x

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