SynthesisJournal of orthopaedic surgery and research2025
Abnormal metal ion levels following spinal instrumentation surgery.
Synthesis in Journal of orthopaedic surgery and research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
3 citing papers in PubMed.
- Metal hypersensitivity in spinal surgery: mechanisms, diagnosis, and management - a narrative review.Annals of medicine and surgery (2012) · 2026Article
- Effect of mixing dissimilar metals on serum metal ion levels following spinal deformity surgery.Spine deformity · 2026Observational
- Guided posterior vertebral growth modulation. A novel fusionless technique for correction of adolescent idiopathic scoliosis in immature patients with removal of the implants at maturity.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe incidence of abnormal metal ion levels following spinal surgery has been inconsistent across various studies. Metal implants, commonly used in spinal surgeries, can release ions that may accumulate in the bloodstream, leading to potential adverse health effects. Therefore, a comprehensive meta-analysis is necessary to assess the levels of metal ions in patients after spinal surgery.
methodsWe performed a systematic review and meta-analysis to evaluate metal ion levels after spinal surgery. A thorough search was conducted across four databases (PubMed, Embase, Web of Science, and Cochrane Library) up to September 2024. Studies were included if they measured serum or whole blood levels of metals such as chromium, cobalt, titanium, nickel, aluminum, or other relevant ions in patients post-spinal surgery. Data were extracted and analyzed using random-effects models to account for variability between studies. Funnel plots and Egger's test were used to assess publication bias, and I
resultsA total of thirty-one studies, comprising data from over 1,404 patients, met the inclusion criteria. Postoperative levels of chromium, titanium, cobalt, aluminum, and nickel were significantly elevated compared to preoperative levels. The pooled standardized mean difference (SMD) for chromium was 2.50 (95% CI 1.74-3.26), for titanium was 2.05 (95% CI 1.41-2.70), for cobalt was 2.28 (95% CI 1.24-3.32), for aluminum was 0.75 (95% CI 0.24-1.27), and for nickel was 1.41 (95% CI 0.03-2.79). Subgroup analyses revealed variations based on the type of surgery, with higher SMDs observed in degenerative spinal conditions compared to scoliosis and spinal deformity-related surgeries for most metals. Significant heterogeneity was observed among studies (I
conclusionThis meta-analysis confirms a significant postoperative increase in metal ion levels, particularly for chromium, titanium, cobalt, aluminum, and nickel, in patients following spinal surgery. These elevated metal ion levels raise concerns about potential long-term health risks, underscoring the importance of postoperative monitoring. Given the high heterogeneity among studies, more robust and standardized research is needed to establish clear clinical thresholds for safe metal ion levels and to assess the long-term implications of these findings. Regular monitoring of metal ion concentrations in patients with spinal implants may be crucial for early detection and prevention of metal-related complications.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.