Metallosis: A complication in the guided growing rod system used in treatment of scoliosis

Soft tissue reaction following metallic debris formation with the use of guided growing rod system has not been previously reported in human. The purpose of this study is to report complications caused by metallosis in a guided growing rod system. A 9-year-old female patient, who underwent treatment for the progressive idiopathic scoliosis (with Cobb's angle of 71°) with the guided growing rod system. Her Cobb's angle was corrected to 13° with the index surgery. During the 5 years postoperative period, she manifested recurrent episodes of skin irritation and progressive worsening of lateral curvature of the spine to an angle of 57°. Furthermore, at her final followup, Risser stage 4 with a gain in height of 26.4 cm was achieved. Considering adequate growth attainment and deterioration in the curvature, revision surgery with fusion was performed. Postoperative Cobb's angle of 23° was achieved with the final correction. During the revisional surgery, signs of implant wear and metallosis were observed at the location of the unconstrained screws. On histological evaluation, chronic inflammation with foreign body granules was seen. However, titanium level in the body was within normal range. She was discharged without any complications. More research on implant wear as a complication in the guided growing rod system is necessary before its widespread use. The occurrence of metallosis with the use of guided growing rod system in growing young children should be considered, when designing the implants.