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Epidural Metalloma 12 Years After Spinal Fusion for Adolescent Idiopathic Scoliosis: A Case Report
Janez Mohar1,2, René Mihalič1,2, Dejan Čeleš1
1Department of Spine Surgery, Valdoltra Orthopaedic Hospital, Jadranska Cesta 31, 6280 Ankaran, Slovenia.
Introduction:
The occurrence of metallosis after spine surgery is a rare phenomenon. The accumulation and deposition of metallic nanoparticles, especially cobalt and chromium, elicit a local inflammatory response by modulating the expression of cytokines, ultimately manifesting as a pseudotumor. This process is considered an aseptic lymphocyte-dominated vasculitis-associated lesion or adverse local tissue reaction (ALTR).
Methods:
We present a case of metalloma that developed 12 years after surgery for adolescent idiopathic scoliosis (AIS).
Results:
After a piecemeal decompression of the pseudocyst, additional internal fixation instrumentation, and a pseudarthrosis revision with bone transplantation, the patient regained all prior flexibility and remained pain free.
Conclusion:
We speculate that the proposed mechanism of instrumentation failure in our patient was over-aggressive postoperative exercise with pseudoarthrosis and metal-on-metal corrosion, leading to ALTR in the spinal canal.
