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Published on: September 11, 2018
Prevalence of metal hypersensitivity in pediatric spine surgery
A Scott Emmert1, Tiffany Ruan1, Michael G Sherenian2
1Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45242, USA.
Insights
This study found that only 3% of pediatric spine surgery patients had confirmed metal hypersensitivity after testing, with nickel being most common. Routine pre-operative testing is not needed unless a patient has a prior metal allergy history.
Area of Science:
- Orthopedic Surgery
- Allergy and Immunology
- Pediatric Medicine
Background:
- Delayed metal hypersensitivity reactions pose a risk for complications in spine surgery.
- Prevalence data for metal hypersensitivity in pediatric spine surgery patients is lacking.
Purpose of the Study:
- To determine the prevalence of metal hypersensitivity in pediatric patients undergoing spinal instrumentation.
Main Methods:
- Retrospective chart review of 796 pediatric patients undergoing spinal instrumentation (2014-2020).
- Pre-operative screening for allergic diseases and metal reactions.
- Patch metal allergy testing (PMAT) for metal hypersensitivity.
Main Results:
- 15% initially screened positive for metal hypersensitivity, but only 3% (26 patients) were confirmed by PMAT.
- Nickel hypersensitivity was most prevalent (2.5% of all patients).
- Other prevalent hypersensitivities included cobalt (1.1%), manganese (0.4%), and copper (0.1%).
Conclusions:
- Routine pre-operative patch metal allergy testing is not indicated for all pediatric spine surgery patients.
- Consider PMAT for pediatric patients with a documented history of prior metal hypersensitivity reactions.
Purpose:
Delayed metal hypersensitivity reactions can cause complications in spine surgery. Currently, there is no information on the prevalence of metal hypersensitivity in pediatric patients undergoing spine surgery. The objective of this study is to determine the prevalence of metal hypersensitivity in pediatric patients undergoing spinal instrumentation.
Methods:
Retrospective chart review of patients who underwent spinal instrumentation with or without fusion at a single institution, from January 1, 2014, to December 31, 2020, was performed. Patients were pre-screened for history of allergic diseases, including previous reaction to metals, prior to surgery. Patch metal allergy testing (PMAT) for metal hypersensitivity was also performed.
Results:
Of the 796 pediatric patients who underwent spinal instrumentation procedures from 2014 to 2020, 118 (15%) screened positive for metal hypersensitivity. However, the number of patients with documented evidence of metal hypersensitivity diminished to 26 (3%) after PMAT verification. Nickel hypersensitivity was most prevalent, with 20 patients (16.9% of positive screening; 2.5% of all instrumented patients) demonstrating positive skin patch tests. The other most prevalent metal hypersensitivities included cobalt in 9 patients (7.6%; 1.1%), manganese in 3 patients (2.5%; 0.4%), and copper in 1 patient (0.8%; 0.1%). with a number needed to treat (NNT) of 5.
Conclusions:
This study suggests that routine pre-operative PMAT is not necessary in all pediatric spine patients yet should be considered if patients report a history of prior metal hypersensitivity reactions.
