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Case Reports
. 2025 Jun 2;59(9):1585-1588.
doi: 10.1007/s43465-025-01425-2. eCollection 2025 Sep.

Epidural Metalloma 12 Years After Spinal Fusion for Adolescent Idiopathic Scoliosis: A Case Report

Janez Mohar  1   2 , René Mihalič  1   2 , Dejan Čeleš  1
Affiliations
Case Reports

Epidural Metalloma 12 Years After Spinal Fusion for Adolescent Idiopathic Scoliosis: A Case Report

Janez Mohar et al. Indian J Orthop. .

Abstract

Introduction: The occurrence of metallosis after spine surgery is a rare phenomenon. The accumulation and deposition of metallic nanoparticles, especially cobalt and chromium, elicit a local inflammatory response by modulating the expression of cytokines, ultimately manifesting as a pseudotumor. This process is considered an aseptic lymphocyte-dominated vasculitis-associated lesion or adverse local tissue reaction (ALTR).

Methods: We present a case of metalloma that developed 12 years after surgery for adolescent idiopathic scoliosis (AIS).

Results: After a piecemeal decompression of the pseudocyst, additional internal fixation instrumentation, and a pseudarthrosis revision with bone transplantation, the patient regained all prior flexibility and remained pain free.

Conclusion: We speculate that the proposed mechanism of instrumentation failure in our patient was over-aggressive postoperative exercise with pseudoarthrosis and metal-on-metal corrosion, leading to ALTR in the spinal canal.

Keywords: Corrosion; Neoplasms; Pseudoarthrosis; Return to sport; Scoliosis.

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Conflict of interest statement

Conflict of interestJanez Mohar, René Mihalič, and Dejan Čeleš declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Anteroposterior and lateral radiographs of the patient’s spine. Thoracic Cobb angle, 47°; lumbar Cobb angle, 37°; central sacral vertical line, sagittal vertical axis (19 mm); L1–S1 lumbar lordosis, 70°; pelvic tilt, 12°; sacral slope, 52°; and T5–T12 thoracic kyphosis, 43° (red lines). Dislodged set screws are visible on the lateral projection (yellow arrow)
Fig. 2
Fig. 2
Coronal and axial computed tomography images showing pseudarthrosis (red arrow) and a bone cyst (yellow arrow)
Fig. 3
Fig. 3
Sagittal magnetic resonance imaging showing lobulated epidural cystic formation (blue arrow)
Fig. 4
Fig. 4
Histopathological image of the metalloma. Microscopic image of connective tissue (green arrow) with black metal debris within macrophages (yellow arrow); hematoxylin and eosin staining, 400 × magnification
See this image and copyright information in PMC

References

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