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A Review Of The Biologic Effects Of Spine Implant Debris: Fact From Fiction

Nadim James Hallab
Published 2009 · Medicine
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Background Biologic-reactivity to implant-debris is the primary determinant of long-term clinical performance. The following reviews: 1) the physical aspects of spinal-implant debris and 2) the local and systemic biologic responses to implant debris. Methods Methods included are: 1) gravimetric wear analysis; 2) SEM and LALLS; 3) metal-ion analysis; 4) ELISA, toxicity testing, patch testing; and 5) metal-lymphocyte transformation testing (metal-LTT). Results Wear and corrosion of spine-implants produce particles and ions. Particles (0.01–1000 μm) are generally submicron ( <1 µm). Wear rates of metal-on-polymer and metal-on-metal disc arthroplasties are approximately 2–20 and 1 mm3/yr, respectively. Metal-on-metal total disc replacement components have significant increases in circulating metal (less than 10-fold that of controls at 4 ppb-Co and 3 ppb-Cr or ng/mL). Debris reactivity is local and systemic. Local inflammation is caused primarily by ingestion of debris by local macrophages, which produce pro-inflammatory cytokines TNFα, IL-1β, IL-6, and PGE2. Systemic responses associated with implant-debris have been limited to hypersensitivity reactions. Elevated amounts of in the liver, spleen, etc of patients with failed TJA have not been associated with remote toxicological or carcinogenic pathology to date. Implant debris are differentially bioreactive. Greater numbers are pro-inflammatory; the smaller-sized debris are more bioreactive by virtue of their greater numbers (dose) for a given amount of implant mass loss (one 100-μm-diameter particle is equivalent in mass to 1 million 1-μm-diameter particles). Elongated particles are pro-inflammatory (ie, aspect ratio of greater than 3). Metal particles are more proinflammatory than polymers, ceteris paribus. Conclusion Spinal arthroplasty designs have been in use for more than 20 years internationally; therefore, concerns about neuropathology, toxicity, and carcinogenicity are mitigated. Debris-induced inflammation still depends on the individual and the type of debris. The consequence of debris-induced inflammation is continued; vigilance by physicians is recommended monitoring of spinal implants using physical exams and testing of metal content and bioreactivity, as is planning for the likelihood of revision in younger individuals.
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Corrosive and cytotoxic properties of compact specimens and microparticles of Ni-Cr dental alloy.
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Spinal Cord Cellular Response To Wear Debris From Metal-on-Metal Total Disc Replacements
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Evaluation of the biological effect of Ti generated debris from metal implants: ions and nanoparticles.
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Precipitates in Biomedical Co-Cr Alloys
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Systemic and local toxicity of metal debris released from hip prostheses: A review of experimental approaches.
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Hydrocolloid versus silicone gel for the prevention of nasal injury in newborns submitted to noninvasive ventilation: A randomized clinical trial
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Co-Cr Alloys as Effective Metallic Biomaterials
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Effect of magnesium on mechanical properties of binary Zn–Mg alloys
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Assessment of epidural versus intradiscal biocompatibility of PEEK implant debris: an in vivo rabbit model
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Evaluation of Titanium Serum Levels in Patients After Spine Instrumentation: Comparison Between Posterolateral and 360º Spinal Fusion Surgery
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Differential toxicity of processed and non-processed states of CoCrMo degradation products generated from a hip simulator on neural cells
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Development of a low imaging signature cervical spine disc arthroplasty
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Materials and Their Failure Mechanisms in Total Disc Replacement
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Does impaction of titanium-coated interbody fusion cages into the disc space cause wear debris or delamination?
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