Failure of facet replacement system with metal-on-metal bearing surface and subsequent discovery of cobalt allergy: Report of 2 cases

Matthew Goodwin, William Ryan Spiker, Darrel S. Brodke, Brandon D. Lawrence

Research output: Contribution to journalArticle

Abstract

The aim of this study was to report on 2 patients in whom metal-on-metal (MOM) facet replacements failed, with subsequent positive findings on allergy testing. Motion-preserving devices have been used with limited success when instrumentation is indicated in the mobile spine. MOM-bearing surfaces in orthopedics were developed to increase implant longevity, yet have been associated with numerous adverse outcomes, including local tissue reactions, pseudotumors, metallosis, and the need for revision surgery. Five patients with spinal stenosis and low-grade spondylolisthesis were randomized to undergo facet replacement surgery with the ACADIA facet replacement system at the authors’ institution. Two patients experienced a return of neurological symptoms after a pain-free interval (< 2 years) with development of local tissue reaction and positive findings on allergy testing to cobalt, the metal in the MOM-bearing surface. Both patients underwent successful removal of the implant and revision to titanium posterior spinal fusion and interbody fusion without further complication. Motion-preserving devices have been designed and trialed for specific indications in the mobile spine. Given the adverse results from MOM devices in hip arthroplasty and now the early reports with MOM facet replacements, caution is warranted when moving forward with any MOM joint–bearing surface. Both patients presented here had an unusual tissue reaction locally and subsequent positive allergy testing results to cobalt. These 2 patients appear to have developed a delayed hypersensitivity reaction to the metal, likely from fine debris at the MOM interface.

Original languageEnglish (US)
Pages (from-to)81-84
Number of pages4
JournalJournal of Neurosurgery: Spine
Volume29
Issue number1
DOIs
StatePublished - Jul 1 2018
Externally publishedYes

Fingerprint

Cobalt
Hypersensitivity
Metals
Equipment and Supplies
Spine
Spondylolisthesis
Spinal Stenosis
Spinal Fusion
Delayed Hypersensitivity
Titanium
Reoperation
Arthroplasty
Orthopedics
Hip

Keywords

  • ACADIA facet replacement system
  • AFRS
  • Cobalt
  • Metal allergy
  • Metal-on-metal
  • Spondylolisthesis

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

Failure of facet replacement system with metal-on-metal bearing surface and subsequent discovery of cobalt allergy : Report of 2 cases. / Goodwin, Matthew; Spiker, William Ryan; Brodke, Darrel S.; Lawrence, Brandon D.

In: Journal of Neurosurgery: Spine, Vol. 29, No. 1, 01.07.2018, p. 81-84.

Research output: Contribution to journalArticle

Goodwin, Matthew ; Spiker, William Ryan ; Brodke, Darrel S. ; Lawrence, Brandon D. / Failure of facet replacement system with metal-on-metal bearing surface and subsequent discovery of cobalt allergy : Report of 2 cases. In: Journal of Neurosurgery: Spine. 2018 ; Vol. 29, No. 1. pp. 81-84.
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