%0 Journal Article
%T The Biological Effects of Combining Metals in a Posterior Spinal Implant: In Vivo Model Development Report of the First Two Cases
%A Christine L. Farnsworth
%A Peter O. Newton
%A Eric Breisch
%A Michael T. Rohmiller
%A Jung Ryul Kim
%A Behrooz A. Akbarnia
%J Advances in Orthopedic Surgery
%D 2014
%R 10.1155/2014/761967
%X Study Design. Combinations of metal implants (stainless steel (SS), titanium (Ti), and cobalt chrome (CC)) were placed in porcine spines. After 12 months, tissue response and implant corrosion were compared between mixed and single metal junctions. Objective. Model development and an attempt to determine any detriment of combining different metals in posterior spinal instrumentation. Methods. Yucatan mini-pigs underwent instrumentation over five unfused lumbar levels. A SS rod and a Ti rod were secured with Ti and SS pedicle screws, SS and Ti crosslinks, SS and CC sublaminar wires, and Ti sublaminar cable. The resulting 4 SS/SS, 3 Ti/Ti, and 11 connections between dissimilar metals per animal were studied after 12 months using radiographs, gross observation, and histology (foreign body reaction (FBR), metal particle count, and inflammation analyzed). Results. Two animals had constructs in place for 12 months with no complications. Histology of tissue over SS/SS connections demonstrated 11.1 ¡À 7.6 FBR cells, 2.1 ¡À 1.7 metal particles, and moderate to extensive inflammation. Ti/Ti tissue showed 6.3 ¡À 3.8 FBR cells, 5.2 ¡À 6.7 particles, and no to extensive inflammation (83% extensive). Tissue over mixed components had 14.1 ¡À 12.6 FBR cells and 13.4 ¡À 27.8 particles. Samples surrounding wires/cables versus other combinations demonstrated FBR (12.4 ¡À 13.5 versus 12.0 ¡À 9.6 cells, P = 0.96), particles (19.8 ¡À 32.6 versus 4.3 ¡À 12.7, P = 0.24), and inflammation (50% versus 75% extensive, P = 0.12). Conclusions. A nonfusion model was developed to study corrosion and analyze biological responses. Although no statistical differences were found in overlying tissue response to single versus mixed metal combinations, galvanic corrosion between differing metals is not ruled out. This pilot study supports further investigation to answer concerns when mixing metals in spinal constructs. 1. Introduction Metal spinal implants are not routinely removed, so corrosion over potentially several decades is a concern [1, 2]. Any movement between metal surfaces, even on the microscopic level, results in etching of the softer surface and often produces wear debris. As the metallic debris oxidizes or corrodes, the particles harden, causing abrasion and more severe etching, resulting in a cycle of implant destruction. Corrosion complications in spinal surgery are related to both loss of implant integrity and biological responses and include infection, toxicity, deterioration of construct strength, and pain [3]. Spine surgeons have experience with visualizing debris and darkened
%U http://www.hindawi.com/journals/aos/2014/761967/