Rare Systemic Response to Titanium Spinal Fusion Implant: Case Report

Neurosurgical patients with titanium spinal implant hypersensitivity can be difficult to diagnosis due to its rarity. Suspicion for titanium allergy is generally localized to the hardware site and may initially be thought to be an infectious process. Patients who report anorexia and fatigue over a long duration after the initial post-operative period may be diagnosed with depression rather than a systemic response to spinal metallic instrumentation. To our knowledge, a systemic titanium hypersensitivity reaction to spinal fixation devices has not been reported in the literature. We offer this report to give spine surgeons additional insight into suspected systemic titanium hypersensitivity symptoms which, if remain unidentified, can severely impair patient outcomes. A 67-year-old female with an unreported nickel allergy developed severe debilitating anorexia and fatigue one month post operatively, secondary to minimally invasive thoracic spinal fixation for T11 burst fracture with disruption of posterior elements. Over a two year period, weight loss reached approximately 25 kilograms with loss of muscle mass and subcutaneous tissue surrounding the spinal implants. The screws and rods were removed to avoid skin erosion. Upon hardware removal, the patient had rapid weight gain, improved stamina and generalized sense of well-being. We recommend the removal of spinal hardware in patients with suspected systemic titanium hypersensitivity reaction.