PDF(Pubmed)
Abstract：
BACKGROUND: Spinal metallosis is a rare complication following spinal instrumentation whereby an inflammatory response to the metal implants results in the development of granulomatous tissue.
METHODS: We describe the case of a 78-year-old woman who had recurrence of back pain 5 years after lumbar spine posterior decompression and instrumented fusion. Lumbar spine radiographs showed hardware loosening and magnetic resonance imaging showed adjacent segment disease. Revision surgery revealed evidence of metallosis intraoperatively.
CONCLUSIONS: Spinal metallosis can present several years after instrumentation. Radiography and computed tomography may demonstrate hardware loosening secondary to metallosis. Blood metal concentrations associated with spinal metallosis have yet to be established. Hence, metallosis is still an intraoperative and histopathological diagnosis. The presence of metallosis after spinal instrumentation likely indicates a more complex underlying problem: Pseudarthrosis, failure to address sagittal balance, infection, and cross-threading of set screws. Hence, identifying metallosis is important, but initiating treatment promptly for symptomatic implant loosening is of greater paramount.
METHODS: We describe the case of a 78-year-old woman who had recurrence of back pain 5 years after lumbar spine posterior decompression and instrumented fusion. Lumbar spine radiographs showed hardware loosening and magnetic resonance imaging showed adjacent segment disease. Revision surgery revealed evidence of metallosis intraoperatively.
CONCLUSIONS: Spinal metallosis can present several years after instrumentation. Radiography and computed tomography may demonstrate hardware loosening secondary to metallosis. Blood metal concentrations associated with spinal metallosis have yet to be established. Hence, metallosis is still an intraoperative and histopathological diagnosis. The presence of metallosis after spinal instrumentation likely indicates a more complex underlying problem: Pseudarthrosis, failure to address sagittal balance, infection, and cross-threading of set screws. Hence, identifying metallosis is important, but initiating treatment promptly for symptomatic implant loosening is of greater paramount.
摘要：
背景：脊柱金属化是脊柱器械治疗后的罕见并发症，其中对金属植入物的炎症反应导致肉芽肿组织的发展。
方法：我们描述了一个78岁的女性，在腰椎后路减压和器械融合后5年复发背痛的案例。腰椎X光片显示硬件松动，磁共振成像显示相邻节段疾病。翻修手术显示术中存在金属化的证据。
结论：脊柱金属病可在器械使用数年后出现。射线照相术和计算机断层扫描可能显示继发于金属化的硬件松动。与脊柱金属病相关的血液金属浓度尚未确定。因此，金属学仍是术中和组织病理学诊断。脊柱器械后金属的存在可能表明一个更复杂的潜在问题：假关节，未能解决矢状平衡，感染,和固定螺钉的交叉螺纹。因此，鉴定金属学很重要，但是，对于有症状的植入物松动，及时开始治疗更为重要。
方法：我们描述了一个78岁的女性，在腰椎后路减压和器械融合后5年复发背痛的案例。腰椎X光片显示硬件松动，磁共振成像显示相邻节段疾病。翻修手术显示术中存在金属化的证据。
结论：脊柱金属病可在器械使用数年后出现。射线照相术和计算机断层扫描可能显示继发于金属化的硬件松动。与脊柱金属病相关的血液金属浓度尚未确定。因此，金属学仍是术中和组织病理学诊断。脊柱器械后金属的存在可能表明一个更复杂的潜在问题：假关节，未能解决矢状平衡，感染,和固定螺钉的交叉螺纹。因此，鉴定金属学很重要，但是，对于有症状的植入物松动，及时开始治疗更为重要。
