Neurological emergency from rare spinal metalloma: Case report and literature review

Metallosis is a rare and poorly understood long-term complication of instrumented surgery that can result in an inflammatory pseudotumor termed metalloma. We describe a particularly unique case and compare it to 6 analogous cases identified by PubMed and/or Medline search through July 2020. A 79-yea...

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Bibliographic Details
Published in:Radiology case reports 2022-05, Vol.17 (5), p.1540-1548
Main Authors: Mazur-Hart, David J., Larson, Erik W., Yaghi, Nasser K., Halfpenny, Aaron M., Pettersson, David R., Yam, David A.
Format: Article
Language:English
Subjects:
Instrumentation
Metalloma
Metallosis
Spinal
Spine
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Summary:Metallosis is a rare and poorly understood long-term complication of instrumented surgery that can result in an inflammatory pseudotumor termed metalloma. We describe a particularly unique case and compare it to 6 analogous cases identified by PubMed and/or Medline search through July 2020. A 79-year-old male with multiple prior spinal lumbar fusion procedures presented with progressive weakness and pain. Imaging revealed a large mass surrounding the right-sided paraspinal rod with extension into the spinal canal, neural foramina, extraforaminal spaces, psoas muscle, marrow spaces, and right sided pedicles. The case presented is a unique example of a unilateral metalloma with mixed-metal instrumentation that created a progressive neurologic deficit without infection, pseudoarthrosis, or hardware failure. This case highlights the lack of understanding regarding the pathophysiology of metallosis and metalloma in spinal instrumentation. We highlight the imaging findings of metalloma to encourage early identification for removal and decompression.
ISSN:1930-0433
1930-0433
DOI:10.1016/j.radcr.2022.01.041