{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T12:16:00Z","timestamp":1777464960085,"version":"3.51.4"},"reference-count":19,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,1,20]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:p>Cobaltism is a well-defined common complication of cobalt-chromium arthroprosthetic implants but has not been previously reported from cobalt-chromium spinal components. Orthopaedic implant cobaltism (OIC) is a spectrum illness, and its severity relates to the magnitude of cobalturia and cobaltaemia and duration of implantation of the wearing or corroding cobalt-chromium component. This case report demonstrates a patient with OIC from failed scoliosis instrumentation using cobalt-chromium rods that both corroded at multiple interfaces with titanium alloy pedicle screws and fractured at the lumbosacral pseudoarthrosis. This patient\u2019s symptoms included tremors, cognitive decline, insomnia and visual changes. The diagnosis of OIC was confirmed when peri-implant fluid returned a cobalt greater than 4800 mcg\/L and peri-implant tissue showed obvious signs of metallosis. Following the revision surgery without cobalt-containing implants, the patient\u2019s symptoms improved and the blood-cobalt has returned to near-normal values. This is the first reported case of reversible OIC from spinal implants.<\/jats:p>","DOI":"10.1136\/bcr-2024-263748","type":"journal-article","created":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T09:35:30Z","timestamp":1738575330000},"page":"e263748","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Orthopaedic implant cobaltism from spinal instrumentation"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8936-7292","authenticated-orcid":false,"suffix":"III","given":"Jack Donovan","family":"Sedwick","sequence":"first","affiliation":[{"name":"University of Washington School of Medicine, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Tower","sequence":"additional","affiliation":[{"name":"Tower Orthopedic and Joint Replacement, Anchorage, Alaska, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Bridges","sequence":"additional","affiliation":[{"name":"Aegis Imaging Consultants, Girdwood, Alaska, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Flanum","sequence":"additional","affiliation":[{"name":"Orthopedic Physician Alaska, Anchorage, Alaska, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,2,3]]},"reference":[{"key":"2025082702112142000_18.2.e263748.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0295203","article-title":"The association of cobalturia with cobaltism symptoms a prospective blinded study of 229 post-arthroplasty patients","volume":"18","author":"Tower","year":"2023","journal-title":"PLoS ONE"},{"key":"2025082702112142000_18.2.e263748.2","doi-asserted-by":"publisher","DOI":"10.1097\/PTS.0000000000000220"},{"key":"2025082702112142000_18.2.e263748.3","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1530\/EOR-21-0098","article-title":"Prosthetic hip-associated cobalt toxicity: a systematic review of case series and case reports","volume":"7","author":"Crutsen","year":"2022","journal-title":"EFORT Open Rev"},{"key":"2025082702112142000_18.2.e263748.4","doi-asserted-by":"crossref","unstructured":"MacDonald SJ , McCalden RW , Chess DG , et al . 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Potential cobalt toxicity from corrosion of fractured cobalt spinal rods. 2023."},{"key":"2025082702112142000_18.2.e263748.15","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.1016\/j.radcr.2022.01.041","article-title":"Neurological emergency from rare spinal metalloma: Case report and literature review","volume":"17","author":"Mazur-Hart","year":"2022","journal-title":"Radiol Case Rep"},{"key":"2025082702112142000_18.2.e263748.16","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.joscr.2023.05.002","article-title":"Blood cobalt levels elevated with rod fracture following posterior spinal fusion in scoliosis: A report of two cases","volume":"2","author":"Tamagawa","year":"2023","journal-title":"JOS Case Reports"},{"key":"2025082702112142000_18.2.e263748.17","doi-asserted-by":"crossref","DOI":"10.1155\/2020\/8475910","article-title":"Comparison of Effectiveness between Cobalt Chromium Rods versus Titanium Rods for Treatment of Patients with Spinal Deformity: A Systematic Review and Meta-Analysis","volume":"2020","author":"Shega","year":"2020","journal-title":"Adv Orthop"},{"key":"2025082702112142000_18.2.e263748.18","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.2106\/00004623-198365080-00012","article-title":"Corrosion of titanium\/cobalt-chromium alloy couples","volume":"65","author":"Kummer","year":"1983","journal-title":"J Bone Joint Surg Am"},{"key":"2025082702112142000_18.2.e263748.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0089693","article-title":"The role of surgery in global health: analysis of United States inpatient procedure frequency by condition using the Global Burden of Disease 2010 framework","volume":"9","author":"Rose","year":"2014","journal-title":"PLoS ONE"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-263748","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:11:30Z","timestamp":1756285890000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-263748"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":19,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2,3]]},"published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1136\/bcr-2024-263748"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-263748","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2]]}}}