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Delayed hypersensitivity reaction caused by metal-on-metal total disc replacement
Fahed Zairi1, Jean Michel Remacle, Mohamed Allaoui
1Department of Neurosurgery, Lille University Hospital, France. fahed.zairi@gmail.com
Journal of Neurosurgery. Spine
|July 9, 2013
Summary
Metal-on-metal total disc replacement (TDR) can cause hypersensitivity reactions. A patient developed cauda equina syndrome due to a TDR device, highlighting potential complications of systemic metal release.
Area of Science:
- Orthopedic Surgery
- Neurosurgery
- Toxicology
Background:
- Discogenic back pain is a common condition often treated with surgical interventions.
- Metal-on-metal total disc replacement (TDR) devices have been utilized for treating degenerative disc disease.
Observation:
- A 53-year-old woman experienced recurrent pain and developed cauda equina syndrome two months after TDR surgery.
- Radiological and biological assessments revealed an inflammatory polyneuropathy and an epidural mass.
- Patch testing indicated a Type IV hypersensitivity reaction to cobalt and chromium.
Findings:
- The patient's symptoms were attributed to a cell-mediated hypersensitivity reaction to the metal-on-metal TDR device.
- Systemic release of metal ions from the implant triggered an adverse inflammatory response.
Implications:
- This case highlights the potential risk of systemic metal release and hypersensitivity reactions associated with metal-on-metal TDR.
- Clinicians should consider metal hypersensitivity in patients presenting with neurological deficits after TDR implantation.
- Further research into the long-term safety and biocompatibility of metal-on-metal implants is warranted.
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