TY - JOUR
T1 - Failure of facet replacement system with metal-on-metal bearing surface and subsequent discovery of cobalt allergy
T2 - Report of 2 cases
AU - Goodwin, Matthew L.
AU - Spiker, William Ryan
AU - Brodke, Darrel S.
AU - Lawrence, Brandon D.
N1 - Funding Information:
Globus Medical Inc. provided funding for this study. Dr. Spiker: consultant for NEXXT Orthopaedics and K2M, and fellowship support from DePuy Synthes.
Publisher Copyright:
© AANS 2018.
PY - 2018/7
Y1 - 2018/7
N2 - The aim of this study was to report on 2 patients in whom metal-on-metal (MOM) facet replacements failed, with subsequent positive findings on allergy testing. Motion-preserving devices have been used with limited success when instrumentation is indicated in the mobile spine. MOM-bearing surfaces in orthopedics were developed to increase implant longevity, yet have been associated with numerous adverse outcomes, including local tissue reactions, pseudotumors, metallosis, and the need for revision surgery. Five patients with spinal stenosis and low-grade spondylolisthesis were randomized to undergo facet replacement surgery with the ACADIA facet replacement system at the authors’ institution. Two patients experienced a return of neurological symptoms after a pain-free interval (< 2 years) with development of local tissue reaction and positive findings on allergy testing to cobalt, the metal in the MOM-bearing surface. Both patients underwent successful removal of the implant and revision to titanium posterior spinal fusion and interbody fusion without further complication. Motion-preserving devices have been designed and trialed for specific indications in the mobile spine. Given the adverse results from MOM devices in hip arthroplasty and now the early reports with MOM facet replacements, caution is warranted when moving forward with any MOM joint–bearing surface. Both patients presented here had an unusual tissue reaction locally and subsequent positive allergy testing results to cobalt. These 2 patients appear to have developed a delayed hypersensitivity reaction to the metal, likely from fine debris at the MOM interface.
AB - The aim of this study was to report on 2 patients in whom metal-on-metal (MOM) facet replacements failed, with subsequent positive findings on allergy testing. Motion-preserving devices have been used with limited success when instrumentation is indicated in the mobile spine. MOM-bearing surfaces in orthopedics were developed to increase implant longevity, yet have been associated with numerous adverse outcomes, including local tissue reactions, pseudotumors, metallosis, and the need for revision surgery. Five patients with spinal stenosis and low-grade spondylolisthesis were randomized to undergo facet replacement surgery with the ACADIA facet replacement system at the authors’ institution. Two patients experienced a return of neurological symptoms after a pain-free interval (< 2 years) with development of local tissue reaction and positive findings on allergy testing to cobalt, the metal in the MOM-bearing surface. Both patients underwent successful removal of the implant and revision to titanium posterior spinal fusion and interbody fusion without further complication. Motion-preserving devices have been designed and trialed for specific indications in the mobile spine. Given the adverse results from MOM devices in hip arthroplasty and now the early reports with MOM facet replacements, caution is warranted when moving forward with any MOM joint–bearing surface. Both patients presented here had an unusual tissue reaction locally and subsequent positive allergy testing results to cobalt. These 2 patients appear to have developed a delayed hypersensitivity reaction to the metal, likely from fine debris at the MOM interface.
KW - ACADIA facet replacement system
KW - AFRS
KW - Cobalt
KW - Metal allergy
KW - Metal-on-metal
KW - Spondylolisthesis
UR - http://www.scopus.com/inward/record.url?scp=85049739530&partnerID=8YFLogxK
U2 - 10.3171/2017.10.SPINE17862
DO - 10.3171/2017.10.SPINE17862
M3 - Article
C2 - 29652237
AN - SCOPUS:85049739530
SN - 1547-5654
VL - 29
SP - 81
EP - 84
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 1
ER -