Metal Hypersensitivity After Spinal Instrumentation: When to Suspect and How to Treat

Background: Metal hypersensitivity is a rare complication after spinal implant placement but is related to significant clinical challenges including implant failure and poor wound healing. The incidence is likely underreported secondary to challenges with diagnosis and retreatment options. Case Description: We present the case of a 41-year-old woman with metal hypersensitivity 6 years status post anterior lumbar interbody fusion after a previously failed revision procedure who presented with low back pain and abdominal pain with food intolerance. Diagnostics revealed presacral fluid collection, which was negative for infection. A detailed workup ruled out other possible differential diagnoses and confirmed hypersensitivity to nickel. Intraoperatively, the interbody was loose but difficult to remove secondary to scar tissue. Ultimately, it was successfully replaced with a polyetheretherketone interbody, which did not contain nickel. Conclusions: Metal hypersensitivity is likely an underreported complication in spine literature that is associated with poor outcomes. Further research to create evidence-based guidelines on diagnosis and retreatment options will facilitate diagnosis, reduce time to revision surgery, and ultimately decrease patient suffering.