J Korean Neurosurg Soc.  2016 Nov;59(6):647-649. 10.3340/jkns.2016.59.6.647.

Foreign Body Reaction after Implantation of a Device for Intervertebral Assisted Motion

• Seo JY
• Ha KY
• Kim YH
• Ahn JH

• KMID: 2417350
• DOI: http://doi.org/10.3340/jkns.2016.59.6.647

Abstract

The device for intervertebral assisted motion (DIAM) is a dynamic implant that consists of a silicone bumper enveloped by a polyethylene terephthalate (PET) fiber sack. Silicone and PET were used because of their biological inertness, but repetitive motion of the spine can cause wear on the implant nonetheless. The purpose of this study is to report a case of foreign body reaction (FBR) against a DIAM. A 72-year-old female patient presented with lower back pain and both legs radiating pain. She had undergone DIAM implantation at L4-5 for spinal stenosis 5 years previously. The intervertebral disc space of L4-5, where the DIAM was inserted, had collapsed and degenerative scoliosis had developed due to left-side collapse. MRI showed L3-4 thecal sac compression and left L4-5 foraminal stenosis. The patient underwent removal of the DIAM and instrumented fusion from L3 to L5. During surgery, fluid and granulation tissue were evident around the DIAM. Histopathology showed scattered wear debris from the DIAM causing chronic inflammation due to the resulting FBR. A FBR due to wear debris of a DIAM can induce a hypersensitivity reaction and bone resorption around the implant, causing it to loosen.

Keyword

Device for intervertebral assisted motion; Foreign body reaction; Polyethylene terephthalate; Silicone

MeSH Terms

Aged
Bone Resorption
Constriction, Pathologic
Female
Foreign Bodies*
Foreign-Body Reaction*
Granulation Tissue
Humans
Hypersensitivity
Inflammation
Intervertebral Disc
Leg
Low Back Pain
Magnetic Resonance Imaging
Polyethylene Terephthalates
Scoliosis
Silicon
Silicones
Spinal Stenosis
Spine
Polyethylene Terephthalates
Silicon
Silicones

Figure

• 

  Fig. 1 Post-operative plain radiographs taken 5 years after DIAM insertion showed marked disc space collapse and scoliosis caused by left-side disc space collapse at L4–5, as compared to the immediate postoperative radiographs. Spondylolisthesis of L3 and L4 was also found. DIAM : device for intervertebral assisted motion.

• 

  Fig. 2 MRI showed L3–4 thecal sac compression and left L4–5 foraminal stenosis. Increased signal change indicating fluid collection around the implanted DIAM was evident (white arrows). DIAM : device for intervertebral assisted motion.

• 

  Fig. 3 A : Pathologic findings showing infiltration of polymorphous inflammatory cells and foreign-body-type giant cells (arrows) around the foreign bodies (arrow head). B : Fibrils (arrow heads) from the polyethylene terephthalate fibers sacs of the DIAM. Inflammatory cells, and foreign body type giant cells (arrows) were shown [Hematoxylin-eosin; (A) ×100, (B) ×400)]. DIAM : device for intervertebral assisted motion.

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