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Topic:

Early Onset Scoliosis

Issue:

Spine

Category:

​

Title:

Serum Titanium Levels Remain Elevated But Urine Titanium is Undetectable in Children With Early Onset Scoliosis Undergoing Growth-Friendly Surgical Treatment: A Prospective Study

Author:

Shams, Kameron MD; Jha, Sahil BS; Swallow, Jennylee MS; Caird, Michelle S. MD; Farley, Frances A. MD; Stepanovich, Matthew MD; Li, Ying MD

Journal:

Journal of Pediatric Orthopaedics

Date:

January 2024

Reference:

44(1): p 37-42, DOI: 10.1097/BPO.0000000000002565

Level Of Evidence:

III

# of Patients:

20 EOS patients (6 TGR, 8 MCGR, 6 VEPTR) and 12 controls.

Study Type:

Prospective case-control study

Location:

Not specified

Summary:

This study compares serum titanium levels in children with early onset scoliosis (EOS) treated with growth-friendly surgical treatments (TGR, MCGR, or VEPTR) to age-matched controls, and investigates whether titanium is excreted via urine.

Methods:

Inclusion Criteria: EOS patients with TGR, MCGR, or VEPTR undergoing treatment. Exclusion Criteria: Control patients with no history of metal implant insertion. Intervention: Collection of serum and urine titanium levels in EOS patients with growth-friendly instrumentation. Outcomes Measured: Serum titanium levels Urine titanium levels Comparison between EOS patients and controls Data Analysis: Comparison of serum titanium levels using analysis of variance and binary comparisons.

Exclusions:

Not specified

Results:

Serum Titanium Levels: Control group had no detectable serum titanium (0 ng/mL). EOS patients had a median serum titanium of 4.0 ng/mL (P < 0.001). MCGR and VEPTR groups had higher serum titanium levels compared to the TGR group at both time points (P < 0.01 and P < 0.001, respectively). No significant difference between MCGR and VEPTR groups, even though VEPTR had longer follow-up and more lengthenings (P = 0.399, P = 0.492). Urine Titanium: No detectable urine titanium in any EOS patient.

Conclusions:

Patients with EOS treated with titanium alloy growth-friendly instrumentation have persistently elevated serum titanium levels compared to controls, with no evidence of renal excretion of titanium. Further studies are needed to assess the long-term effects and potential accumulation of titanium in growing children.

Relevance:

Limitations:

Perspective:

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