Surgical instrumentation in children with adolescent idiopathic scoliosis (AIS) is performed early in life and the implants are left in situ for the rest of the patient’s life. Concern has been raised regarding persistent elevated levels of serum metal ions, but only a few studies on the topic have been published. The aim of this study was to compare the levels of serum metal ions in patients with AIS treated with either Harrington rod instrumentation or bracing.
Materials and methods
AIS patients treated with Boston brace (BB) or posterior spinal fusion with Harrington rod instrumentation (HR) from 1983 to 1990 were requested to return to clinic. One hundred fifty-nine (73%) of 219 patients were available for follow-up of whom 115 agreed to have a blood draw.
The proportion of patients who agreed to have a blood draw were similar in the BB (48 of 100, 48%) and HR (67 of 115, 60%, p = 0.085) groups. None of the surgical patients had their implants removed; mean age at follow-up (BB: 43.2 years vs HR: 43.5 years, p = 0.566) and mean length of follow-up (BB: 26.5 years vs HR: 24.5 years). Mean chromium serum levels were similar between the BB (2.7 nmol/L) and the HR (2.9 nmol/L, p = 0.827). Mean Cobalt serum levels were also similar between the BB (2.6 nmol/L) and the HR (2.8 nmol/L, p = 0.200).
Serum metal ions were similar in AIS patients treated with bracing or Harrington rod instrumentation 25 years after initiation of treatment.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Availability of data and materials
Weinstein SL, Dolan LA, Cheng JC et al (2008) Adolescent idiopathic scoliosis. Lancet 371(9623):1527–1537. https://doi.org/10.1016/S0140-6736(08)60658-3
Harrington PR (1962) Treatment of scoliosis. Correction and internal fixation by spine instrumentation. J Bone Jt Surg Am 44-A:591–610
Medicines and Healthcare Products Regulatory Agency. Medical Device Alert. All metal-on-metal (MoM) hip replacements (MDA/2010/033) London: MHRA, 2010
Ulrich M, Overgaard S, Penny J (2014) Metal-on-metal hip arthroplasty. Ugeskr Laeger 176(34)
Gill HS, Grammatopoulos G, Adshead S et al (2012) Molecular and immune toxicity of CoCr nanoparticles in MoM hip arthroplasty. Trends Mol Med 18(3):145–155. https://doi.org/10.1016/j.molmed.2011.12.002
Barceloux DG (1999) Chromium. J Toxicol Clin Toxicol 37(2):173–194. https://doi.org/10.1081/clt-100102418
Barceloux DG (1999) Cobalt. J Toxicol Clin Toxicol 37(2):201–206. https://doi.org/10.1081/clt-100102420
Morin Y, Daniel P (1967) Quebec beer-drinkers’ cardiomyopathy: etiological considerations. Can Med Assoc J 97(15):926–928
Lukina E, Laka A, Kollerov M et al (2016) Metal concentrations in the blood and tissues after implantation of titanium growth guidance sliding instrumentation. Spine J 16(3):380–388. https://doi.org/10.1016/j.spinee.2015.11.040
Cundy TP, Delaney CL, Rackham MD et al (2010) Chromium ion release from stainless steel pediatric scoliosis instrumentation. Spine (Phila Pa 1976) 35(9):967–974. https://doi.org/10.1097/BRS.0b013e3181d53724
Savarino L, Greggi T, Martikos K et al (2015) Long-term systemic metal distribution in patients with stainless steel spinal instrumentation: a case–control study. J Spinal Disord Tech 28(3):114–118. https://doi.org/10.1097/BSD.0b013e31826eaa27
Sherman B, Crowell T (2018) Corrosion of Harrington rod in idiopathic scoliosis: long-term effects. Eur Spine J 27(Suppl 3):298–302. https://doi.org/10.1007/s00586-017-5183-7
McPhee IB, Swanson CE (2007) Metal ion levels in patients with stainless steel spinal instrumentation. Spine (Phila Pa 1976) 32(18):1963–1968. https://doi.org/10.1097/BRS.0b013e318133aa0d
del Rio J, Beguiristain J, Duart J (2007) Metal levels in corrosion of spinal implants. Eur Spine J 16(7):1055–1061. https://doi.org/10.1007/s00586-007-0311-4
Kim YJ, Kassab F, Berven SH et al (2005) Serum levels of nickel and chromium after instrumented posterior spinal arthrodesis. Spine (Phila Pa 1976) 30(8):923–926. https://doi.org/10.1097/01.brs.0000158872.42802.be
Andersen MO, Christensen SB, Thomsen K (2006) Outcome at 10 years after treatment for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 31(3):350–354. https://doi.org/10.1097/01.brs.0000197649.29712.de
Simony A, Hansen EJ, Carreon LY et al (2015) Health-related quality-of-life in adolescent idiopathic scoliosis patients 25 years after treatment. Scoliosis 10:22. https://doi.org/10.1186/s13013-015-0045-8
Simony A, Christensen SB, Carreon LY et al (2015) Radiological outcomes in adolescent idiopathic scoliosis patients more than 22 years after treatment. Spine Deform 3(5):436–439. https://doi.org/10.1016/j.jspd.2015.03.003
Simony A, Hansen EJ, Christensen SB et al (2016) Incidence of cancer in adolescent idiopathic scoliosis patients treated 25 years previously. Eur Spine J 25(10):3366–3370. https://doi.org/10.1007/s00586-016-4747-2
Statistics Denmark. Average age of first-time mothers. https://www.statbank.dk/statbank5a/selectvarval/saveselections.asp?MainTable=FOD11&PLanguage=1&TableStyle=&Buttons=&PXSId=202126184246313782741FOD11&IQY=&TC=&ST=ST&rvar0=&rvar1=&rvar2=&rvar3=&rvar4=&rvar5=&rvar6=&rvar7=&rvar8=&rvar9=&rvar10=&rvar11=&rvar12=&rvar13=&rvar14=. Accessed 31 Jan 2021
Cotrel Y (1978) Techniques for the treatment of idiopathic scoliosis. Int Orthop Spring 1(4):247–265
Cundy WJ, Mascarenhas AR, Antoniou G et al (2015) Local and systemic metal ion release occurs intraoperatively during correction and instrumented spinal fusion for scoliosis. J Child Orthop 9(1):39–43. https://doi.org/10.1007/s11832-015-0631-6
Prikryl M, Srivastava SC, Viviani GR et al (1989) Role of corrosion in Harrington and Luque rods failure. Biomaterials 10(2):109–117. https://doi.org/10.1016/0142-9612(89)90042-2
Wang JC, Yu WD, Sandhu HS et al (1999) Metal debris from titanium spinal implants. Spine (Phila Pa 1976) 24(9):899–903. https://doi.org/10.1097/00007632-199905010-00011
The authors take this opportunity to extend their gratitude to Maha Sakr Alameddine for her assistance in analyzing the blood samples
No funding was received for this work.
Conflict of interest
This study was approved by the Ethical Committee of Southern Denmark, trial number S-20110025.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Sørensen, S.T., Schmedes, A.V., Andersen, M.Ø. et al. Serum metal ion levels in adolescent idiopathic scoliosis (AIS) patients 25 years after treated with Harrington rod instrumentation or bracing. Spine Deform (2021). https://doi.org/10.1007/s43390-021-00365-9
- Metal ion
- Spinal implants