title: Delayed hypersensitivity reaction caused by metal-on-metal total disc replacement.
abstract: The authors report the case of a 53-year-old woman who underwent placement of a metal-on-metal total disc replacement (TDR) device for the treatment of discogenic back pain. The initial postoperative course was normal, but 2 months after surgery she started to complain of a recurrence of pain and she progressively developed cauda equina syndrome. Radiological and biological findings showed an inflammatory polyneuropathy associated with an epidural mass. A diagnosis of cell-mediated hypersensitivity reaction (Type IV) was made after patch testing showed positive reactions for 1% cobalt chloride and chromium. A decision was made to remove the TDR device and to perform a circumferential fusion. This report is intended to inform the reader that systemic metal release and hypersensitivity reaction are possible complications of metal-on-metal TDR.
authors.affiliation: Department of Neurosurgery, Lille University Hospital, France. fahed.zairi@gmail.com
authors.forename: Fahed
authors.initials: F
authors.lastname: Zairi
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Remacle
authors.forename: Mohamed
authors.initials: M
authors.lastname: Allaoui
authors.forename: Richard
authors.initials: R
authors.lastname: Assaker
mesh_terms: D001416:Back Pain / Q000276:immunology / Q000473:pathology / Q000601:surgery; D002857:Chromium / Q000009:adverse effects* / Q000276:immunology; D003035:Cobalt / Q000009:adverse effects* / Q000276:immunology; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000276:immunology / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D011128:Polyradiculopathy / Q000276:immunology / Q000473:pathology / Q000601:surgery; D019736:Prostheses and Implants / Q000009:adverse effects*; D059145:Total Disc Replacement / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D002857:Chromium; D003035:Cobalt