Comparison of Different Surgical Systems for Treatment of Early-onset Scoliosis in the Context of Release of Titanium Ions

Case–control study. OBJECTIVE. The aim of the study was to compare growth-friendly systems: traditional growing rod, guided growth systems (GGS), and vertical expandable prosthetic titanium rib in the context of titanium release. SUMMARY OF BACKGROUND DATA. The problem of scoliosis affects even up to 3% of the population, and ca. 0.1% of patients need surgical treatment. Surgical treatment carries the risk of a long-term presence of implants in the organism, which may result in release of metal ions into the tissues and bloodstream. METHODS. Seventy-one patients (13.5 ± 3.54 years’ old) were treated for spinal deformity using various surgical systems and the samples of paraspinal tissue, blood, nails, and hair were collected before and after treatment. The quantification of titanium was performed using inductively coupled plasma optical emission spectrometry. RESULTS. The metallic particles were released into the peri-implant tissue, and the greatest amounts of titanium were detected in patients with GGS. The concentration of soluble titanium forms in subcutaneous tissue (ST) was low and do not statistically differ from control. The average titanium content in the paraspinal tissue in patients with GGS was two- to three-fold higher than the average value in the other investigated groups. A slightly increased level of titanium compared with the control was noted in all studied groups of patients. The highest content of titanium in blood was observed in patients with the GGS system. CONCLUSION. Neverless the system used, the concentration of soluble titanium forms in both ST and blood was only slightly higher than in the control and did not exceed the allowable levels. The increased level of titanium with GGS system is probably associated with the friction between implant components, whereas the components in the other systems are immobile relative to each other. Level of Evidence: 3