Titanium verses Stainless Steel

[scoliboymom]

I am just wondering about the pros and cons of titanium verses stainless steel.
My sons surgeon will be using stainless steel which surprised me as I just assumed that titanium was the preferred choice these days.

[LindaRacine]

Hi Mom...

I hear the same thing from patients/parents all the time. In the biggest scoliosis centers around the U.S., doctors are still using stainless steel much of the time. You should address your concern with your son's surgeon.

Regards,
Linda

[A User Is Me]

Stainless Steel

According to the book Scoliosis Surgery by David Wolpert, Stainless Steel is stronger and far less expensive. The drawback is that it will distort MRI scans if your son ever needs one and also there is a risk of allergic reaction to the nickel contained in the s.s. in case the rod gets damaged. It can be tested before having surgery, and you should ask doctor for it. Good luck with your son. I am also a worried mom with 15-year old son with L50 and T49 last week (was L42 and T37 in November). The doctor recommends surgery at the end of May when summer vacation starts and I am agonizing over whether to go ahead with the recomendation.

[scoliboymom]

Thanks for your insight. I never even thought about allergic reaction. I will be in touch with my doctor to ask about the testing beforehand.
You would almost think that it should be part of the pre-op but I guess it is very rare and maybe expensive to test. Can't even imagine what they would do if they realise once it's in you that you are allergic to it.
It's good to talk to a parent of another boy with scoliosis as there aren't as many boys around. It looks like his progression is quick too like Patrick's. I agree it is so agonizing to make the decision of surgery and even when you make it there's that nagging feeling that maybe you shouldn't do it. I am beginning to realise that there are far more pros to doing it now then waiting till they are much older.
It sounds like our sons will be in surgery about the same time. We will be given our surgery date next week and it will more then likely be mid may.
Keep us posted as to whats happening and good luck!
Ramona

[LindaRacine]

Hi Ramona...

I have tested as being allergic to nickel, and have never been able to wear anything other than sterling silver or gold earrings because of it. I have, however, had stainless steel implants for more than 13 years without a problem.

My understanding is that the allergic reaction only happens when one of the implant components is loose. When that happens, you'll get one metal part rubbing against another metal part, and "fretting" occurs. (Microscopic pieces of the metal are shed into the surrounding soft tissues.) If the implants are solid and tight, there should not be an allergic reaction.

Regards,
Linda

[vahil]

stainless steel

Our 15 year old son had surgery for kyphosis (99 degree curvature) seven months ago at Shriner's in Philadelphia. They used stainless steel for the two rods and twenty some screw and he has experienced no side effects or problems. He is actually sensitive to things such as perfumes and dies in laundry detergent but there have been no problems from the surgery.

He traveled with me last month and he didn't even set off metal detectors at the airport!

Virginia Dad
15 year old son - Seven Months Post Op
Kyphosis - 99 degrees corrected to 45 degrees

[joeb-z]

According to the book Scoliosis Surgery by David Wolpert, Stainless Steel is stronger and far less expensive. The drawback is that it will distort MRI scans if your son ever needs one and also there is a risk of allergic reaction to the nickel contained in the s.s. in case the rod gets damaged. It can be tested before having surgery, and you should ask doctor for it. Good luck with your son. I am also a worried mom with 15-year old son with L50 and T49 last week (was L42 and T37 in November). The doctor recommends surgery at the end of May when summer vacation starts and I am agonizing over whether to go ahead with the recomendation.

In general the Wolpert book is fine for background but I found it had too much of a reporter's "impartial" "unbiased" perspective rather than cutting to the chase and giving guidance as to how to sort out the merits of the various "viewpoints" based on a particular patients situation.

I would say that titanium implants are superior. Titanium is inert and, while stainless is good in terms of allergies, reactions to metal ions, especially nickel (a poison), in SS give titanium a definate plus. Titanium more closely mimics the resiliency of the natural bone and therefore leads to less stress shielding (bone recedes when not stressed). Early titanium implants may have had more breakage because the designs merely copied stainless designs but the latest generation of titaniym hardware seems very good.

[Singer]

Joeb, will you come to the hospital with me and be my advocate? LOL
You are one of the most informed people on this forum and you're not even a patient (your wife is the patient, right?)!

I find your posts very reassuring for some reason. Perhaps you should hire yourself out as a pre-op consultant.

[emmalouise]

I think as long as your surgeon is comfortable with the equipment it doesn't really matter. They both have their pros & cons. The most important thing is that you trust your surgeon, if he's good, he'll explain to you why he uses the equipment he does, including any complications he's come across.

Just find a surgeon you are completely confident in, and ask.

Kind regards
Em

[emmalouise]

P.S. lol to Singer's post

[terri watkins]

a lil somethin to add

Meeting strength and biocompatibility issues leaves engineers with two choices for spinal implants, stainless steel or titanium. Titanium is by far the metal of choice. It is strong, lightweight, weighing 56% as much as steel, and it is one of the few materials that bone grows into and on. This adds to the structural integrity of the screws. However, it could be problematic if the surgeon has to remove the screws.

Titanium, like all metals, has the drawback in that it is not translucent to X-rays or MRI scans. So once installed, it can blur or hide anatomical changes. But unlike steel, titanium is non-ferrous, so magnets used in MRI machines will not exert a force on them.

[Pips]

I had steel. I had a stiff curve which required a fair amount of leverage to get the correction they did. I was told that since titanium is more brittle there would be more chance of it breaking under those circumstances and so the choice of metal depended on the curve and how much stress it would be under.

I don't know if this is a help.

[terri watkins]

SS vs. Ti

I saw this in the Journal of Orthopaedic Science:


Abstract Spinal implants retrieved from 11 patients with scoliosis were examined. All the implants were posterior instrumentation systems made of 316L stainless steel and composed of rods, hooks, and crosslink connectors. Corrosion was classified into grades 0 to 3 based on macroscopic findings of the rod surface at the junction of each hook or crosslink connector. Grade 0 was defined as no sign of corrosion, grade 1 as surface discoloration, grade 2 as superficial metal loss, and grade 3 as severe metal loss. The depths and characteristics of metal loss areas were examined. Spinal implants showed more corrosion after long-term implantation than after short-term implantation. Corrosion was seen on many of the rod junctions (66.2%) after long-term implantation, but there was no difference between the junction at the hook and those at the crosslink connector. It is thought that intergranular corrosion and fretting contributed to the corrosion of implants. The current study demonstrated that corrosion takes place at many of the rod junctions in long-term implantation. We recommend removal of the spinal implants after solid bony union.

I have taken my son to three surgeons for opinions and found that one uses either SS or Ti (our choice). The second uses only SS and the third uses only Ti. What's a mom to do?

[Carmell]

Hi Terri,

You also need to remember that scoliosis hardware is a business. Some surgeons use only stainless or only titanium because of the contracts they've signed with the manufacturers. Hopefully ALL surgeons have their patients health in their best interest, but I'm afraid that isn't always the case. Sometimes business overshadows what's absolutely best for the patient. I also agree there are pros and cons to both - and there is a time and a place to use either/both. Each patient is unique.

[terri watkins]

Hi Carmell

I thank you for responding. We had another appt with Dr Hey this morning and I asked the question if the contract with the hardware manufacturer influences his decision to use titanium. He stated " The company that provides the hardware I use sells both titanium and stainless steel and I choose titanium alloy for a number of reasons. It is strong,the stuff fighter jets are made out of, light weight and doesn't distort mri images the way SS does." I knew in the back of my mind that the this was possible, but, never posed it as a question until you laid it out for me with your response. I can only hope he was being truthful.
He also told me of something he does during surgery that I found odd. He cuts off the patients spineous process ( I believe that's right... it's on the back side of each vertebrae) and he grinds that up and mixes it with the bone from the bone bank to fill in the areas to fuse to give the donor bone the patients own code so to speak. The other surgeon I talked with only took a sample of the patients blood and spun it down to use the serum over the donor bone for the same purpose... I am still learning and researching as it still helps me ( I think). Thank you for all you help and input you have been and continue to be one of my most valuable resources.