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Local and systemic metal ion release occurs intraoperatively during correction and instrumented spinal fusion for scoliosis.

Cundy WJ, Mascarenhas AR, Antoniou G, Freeman BJ, Cundy PJ - J Child Orthop (2015)

Bottom Line: Measurable metal ion levels were detected in all local samples obtained from wound irrigation fluid, cell saver blood, and fluid that immersed metal universal reduction screw tabs.Postoperative serum metal ion levels were elevated compared to baseline preoperative levels.In general, metal ion levels were considerably higher in the intraoperative fluid samples compared to those observed in the serum levels.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Women's and Children's Hospital, 72 King William Road, North Adelaide, SA, 5006, Australia, william.cundy@adelaide.edu.au.

ABSTRACT

Study design: Prospective pilot study.

Objectives: The aim of this study was to measure titanium, niobium and aluminium levels in various intraoperative and postoperative samples to determine patterns of metal ion release that occur within the first month following instrumented spinal fusion. Raised serum metal ion levels are reported following instrumented spinal fusion in adolescent idiopathic scoliosis. The exact topological origin and chronology of metal ion release remains conjectural. Recent literature suggests an immediate rise in serum metal levels within the first postoperative week.

Methods: Titanium, niobium and aluminium levels were measured before, during and after surgery in serum and local intraoperative fluid samples obtained from two pediatric patients undergoing posterior correction and instrumentation for scoliosis.

Results: Measurable metal ion levels were detected in all local samples obtained from wound irrigation fluid, cell saver blood, and fluid that immersed metal universal reduction screw tabs. Postoperative serum metal ion levels were elevated compared to baseline preoperative levels. In general, metal ion levels were considerably higher in the intraoperative fluid samples compared to those observed in the serum levels.

Conclusion: Our findings of contextually high metal ion concentrations in intraoperative and early postoperative samples provide further empirical support of a 'putting-in' phenomenon of metal ion release following instrumented spinal fusion. This challenges existing beliefs that metal ion release occurs during an intermediate 'wearing-in' phase. We recommend thorough irrigation of the operative site prior to wound closure to dilute and remove intraoperative metal ion debris. Possibilities of filtering trace metal ions from cell saver content may be considered.

No MeSH data available.


Related in: MedlinePlus

Titanium, niobium and aluminium levels from local and systemic fluid samples taken at various time intervals (Fig. 1a, b, c, respectively). Cell saver and wound irrigation data labels represent mean values (n = 2)
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Fig1: Titanium, niobium and aluminium levels from local and systemic fluid samples taken at various time intervals (Fig. 1a, b, c, respectively). Cell saver and wound irrigation data labels represent mean values (n = 2)

Mentions: Raised titanium, niobium and aluminium levels were recorded in the wound irrigation fluid (Fig. 1a, b, c). With the exception of titanium, wound irrigation levels were higher than all serum metal ion samples.Fig. 1


Local and systemic metal ion release occurs intraoperatively during correction and instrumented spinal fusion for scoliosis.

Cundy WJ, Mascarenhas AR, Antoniou G, Freeman BJ, Cundy PJ - J Child Orthop (2015)

Titanium, niobium and aluminium levels from local and systemic fluid samples taken at various time intervals (Fig. 1a, b, c, respectively). Cell saver and wound irrigation data labels represent mean values (n = 2)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4340846&req=5

Fig1: Titanium, niobium and aluminium levels from local and systemic fluid samples taken at various time intervals (Fig. 1a, b, c, respectively). Cell saver and wound irrigation data labels represent mean values (n = 2)
Mentions: Raised titanium, niobium and aluminium levels were recorded in the wound irrigation fluid (Fig. 1a, b, c). With the exception of titanium, wound irrigation levels were higher than all serum metal ion samples.Fig. 1

Bottom Line: Measurable metal ion levels were detected in all local samples obtained from wound irrigation fluid, cell saver blood, and fluid that immersed metal universal reduction screw tabs.Postoperative serum metal ion levels were elevated compared to baseline preoperative levels.In general, metal ion levels were considerably higher in the intraoperative fluid samples compared to those observed in the serum levels.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Women's and Children's Hospital, 72 King William Road, North Adelaide, SA, 5006, Australia, william.cundy@adelaide.edu.au.

ABSTRACT

Study design: Prospective pilot study.

Objectives: The aim of this study was to measure titanium, niobium and aluminium levels in various intraoperative and postoperative samples to determine patterns of metal ion release that occur within the first month following instrumented spinal fusion. Raised serum metal ion levels are reported following instrumented spinal fusion in adolescent idiopathic scoliosis. The exact topological origin and chronology of metal ion release remains conjectural. Recent literature suggests an immediate rise in serum metal levels within the first postoperative week.

Methods: Titanium, niobium and aluminium levels were measured before, during and after surgery in serum and local intraoperative fluid samples obtained from two pediatric patients undergoing posterior correction and instrumentation for scoliosis.

Results: Measurable metal ion levels were detected in all local samples obtained from wound irrigation fluid, cell saver blood, and fluid that immersed metal universal reduction screw tabs. Postoperative serum metal ion levels were elevated compared to baseline preoperative levels. In general, metal ion levels were considerably higher in the intraoperative fluid samples compared to those observed in the serum levels.

Conclusion: Our findings of contextually high metal ion concentrations in intraoperative and early postoperative samples provide further empirical support of a 'putting-in' phenomenon of metal ion release following instrumented spinal fusion. This challenges existing beliefs that metal ion release occurs during an intermediate 'wearing-in' phase. We recommend thorough irrigation of the operative site prior to wound closure to dilute and remove intraoperative metal ion debris. Possibilities of filtering trace metal ions from cell saver content may be considered.

No MeSH data available.


Related in: MedlinePlus