TY - JOUR
T1 - Positive security screening episodes of patients with spinal implants are influenced by detector type and not implant material
AU - Arhewoh, Reme
AU - Kelly, Brian
AU - Kelly, Michael
AU - Buchowski, Jacob M.
AU - Gupta, Munish
AU - Luhmann, Scott J.
N1 - Funding Information:
Author disclosures: RA: Nothing to disclose. BAK: Consulting, Medtronic MPK: Dupuy Synthes (B), International Spine Deformity Group (B, paid directly to institution). JMB: K2M: (c), Wolters Kluwer: (<A), Globus: (E). Fellowship Support (C), AOSpine (B), OmEGA: (C, Paid directly to institution). MCG: Consulting: Medtronic (C), Globus (A). Royalties: Innomed (B), DePuy (G). Stock Ownership: P&G (C-sold in 2020), J&J (C). Trips/Travel: SRS (C, reimbursement and/or hotel for faculty), AO Spine (B, reimbursement and/or hotel for faculty). SJL: Royalties: Stryker (F), Orthopediatrics (A), Globus Medicus (A) Wolters Kluwer (A).
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/5
Y1 - 2022/5
N2 - BACKGROUND CONTEXT: Previous research on rates of spinal detection showed a low frequency of patients (5%) experienced delays and additional screening going through airport security. With continuous technology advances in screenings and the rise in cobalt chrome implantation, updated data on patient experiences was needed. PURPOSE: 1) Assess the rates of detection and additional screening by traditional metal detectors and full body scanners in patients with metal spinal implants, 2) Compare the rates of detection of various metal types (Titanium and cobalt-chrome, titanium only, and stainless steel) STUDY DESIGN: Retrospective PATIENT SAMPLE: All spine surgical follow-ups over survey period. OUTCOME MEASURES: Self-reported open questionnaire; frequency of airport screening, patients’ feelings and attitudes towards screening. METHODS: Patients were surveyed in the outpatient setting on exposure to metal detectors (Traditional and full-body scanners) after spinal surgery with metallic implants at a single institution. A total of 182 patients were identified and consented. The medical records were reviewed for details on implant material and location. RESULTS: Mean age at surgery was 53 years (range=12–88) with a mean 5.9 levels fused (range 2–20). Mean time from surgery to survey was 34 months (range=2–351) and number of airport screenings was 5.8 (range=0–54). The most common implants were titanium/cobalt-chrome (Ti/CoCr) (n=96, 53%) and titanium only (n=72, 40%). Overall, 40% of patients reported a detector alert at an airport requiring processing delay and additional screening: 86% from full body scanners, 54% from traditional metal detectors, and 41% of patients reporting both. Full body scanners were more likely to detect implants compared to traditional metal detectors (OR 5.1, p<.0001). No significant difference in number of screenings between patients who set off detectors and patients who did not (p=.185). Twenty percent of patients reported trouble at non-airport locations with detectors due to their spinal implants, with 70% of these patients reporting additional manual screenings. There was no correlation between levels spanned by the construct and number of times detected by traditional metal detectors or full body scanners, and no significant difference between levels spanned by constructs, or construct locations, in patients who set off detectors and those who did not. There was no significant difference between Ti/CoCr vs. titanium or other constructs in positive screenings. Subanalysis of fusions <5 levels demonstrated Ti/CoCr implants did not have an impact on positive screenings vs. other metal types (OR 0.88, p=.756). Interestingly, there was a significant difference in age and the positive screenings (p=.0025). Patients 60+ years of age had statistically significant greater positive screening than patients 0 to 40 years and 41 to 60 years. This data raises the possibility the presence of total joint arthroplasties (Mean age of patients with arthroplasty 65.5 years, range 50–88) likely play a significant role in the frequency of positive screenings. CONCLUSIONS: 40% of patients had their spinal implants detected at airports and 20% reported detections at other non-airport locations. Full body scanners detect spinal implants more frequently compared to traditional metal detectors (86% vs. 54% of detections, respectively). There was no difference in rate of airport and non-airport detection in patients with cobalt chrome implants compared to other materials. The presence of total joint arthroplasties likely has a significant contribution to the detector alerts.
AB - BACKGROUND CONTEXT: Previous research on rates of spinal detection showed a low frequency of patients (5%) experienced delays and additional screening going through airport security. With continuous technology advances in screenings and the rise in cobalt chrome implantation, updated data on patient experiences was needed. PURPOSE: 1) Assess the rates of detection and additional screening by traditional metal detectors and full body scanners in patients with metal spinal implants, 2) Compare the rates of detection of various metal types (Titanium and cobalt-chrome, titanium only, and stainless steel) STUDY DESIGN: Retrospective PATIENT SAMPLE: All spine surgical follow-ups over survey period. OUTCOME MEASURES: Self-reported open questionnaire; frequency of airport screening, patients’ feelings and attitudes towards screening. METHODS: Patients were surveyed in the outpatient setting on exposure to metal detectors (Traditional and full-body scanners) after spinal surgery with metallic implants at a single institution. A total of 182 patients were identified and consented. The medical records were reviewed for details on implant material and location. RESULTS: Mean age at surgery was 53 years (range=12–88) with a mean 5.9 levels fused (range 2–20). Mean time from surgery to survey was 34 months (range=2–351) and number of airport screenings was 5.8 (range=0–54). The most common implants were titanium/cobalt-chrome (Ti/CoCr) (n=96, 53%) and titanium only (n=72, 40%). Overall, 40% of patients reported a detector alert at an airport requiring processing delay and additional screening: 86% from full body scanners, 54% from traditional metal detectors, and 41% of patients reporting both. Full body scanners were more likely to detect implants compared to traditional metal detectors (OR 5.1, p<.0001). No significant difference in number of screenings between patients who set off detectors and patients who did not (p=.185). Twenty percent of patients reported trouble at non-airport locations with detectors due to their spinal implants, with 70% of these patients reporting additional manual screenings. There was no correlation between levels spanned by the construct and number of times detected by traditional metal detectors or full body scanners, and no significant difference between levels spanned by constructs, or construct locations, in patients who set off detectors and those who did not. There was no significant difference between Ti/CoCr vs. titanium or other constructs in positive screenings. Subanalysis of fusions <5 levels demonstrated Ti/CoCr implants did not have an impact on positive screenings vs. other metal types (OR 0.88, p=.756). Interestingly, there was a significant difference in age and the positive screenings (p=.0025). Patients 60+ years of age had statistically significant greater positive screening than patients 0 to 40 years and 41 to 60 years. This data raises the possibility the presence of total joint arthroplasties (Mean age of patients with arthroplasty 65.5 years, range 50–88) likely play a significant role in the frequency of positive screenings. CONCLUSIONS: 40% of patients had their spinal implants detected at airports and 20% reported detections at other non-airport locations. Full body scanners detect spinal implants more frequently compared to traditional metal detectors (86% vs. 54% of detections, respectively). There was no difference in rate of airport and non-airport detection in patients with cobalt chrome implants compared to other materials. The presence of total joint arthroplasties likely has a significant contribution to the detector alerts.
KW - Cobalt chrome
KW - Full body scanners
KW - Metal detectors
KW - Screening
KW - Spine implant
UR - http://www.scopus.com/inward/record.url?scp=85122539663&partnerID=8YFLogxK
U2 - 10.1016/j.spinee.2021.12.010
DO - 10.1016/j.spinee.2021.12.010
M3 - Article
C2 - 34936885
AN - SCOPUS:85122539663
SN - 1529-9430
VL - 22
SP - 738
EP - 746
JO - Spine Journal
JF - Spine Journal
IS - 5
ER -