The Role of Vascularized Bone Grafts in Spine Surgery

Shin, Alexander Y.; Dekutoski, Mark B.

doi:10.1016/j.ocl.2006.10.011

Cited by 35 publications

(42 citation statements)

References 57 publications

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“…8). 8,51 Ultimately, systematic literature review and pooled analysis support use of vascularized bone grafts for reconstruction of the extensive defects left after resection of primary spinal tumors. Pooled analysis demonstrated very high rates of union (89%) with an acceptable overall complication rate (42%) that is comparable with studies using nonvascularized grafting.…”

Section: Discussionmentioning

confidence: 99%

Vascularized Bone Grafting for Reconstruction of Oncologic Defects in the Spine: A Systematic Review and Pooled Analysis of the Literature

Pedreira

Siotos

Cho

et al. 2018

J reconstr Microsurg

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Our results demonstrate that complication rates using VBG are similar to those reported in studies using non-VBG for similar spinal reconstructions; however, fusion rates are better. Given rapid fusion and possible hardware independence, VBG may be useful in reconstructing defects in patients with longer life expectancies and/or with a history of chemoradiation and/or infection at the site of tumor resection.

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Section: Discussionmentioning

confidence: 99%

Vascularized Bone Grafting for Reconstruction of Oncologic Defects in the Spine: A Systematic Review and Pooled Analysis of the Literature

Pedreira

Siotos

Cho

et al. 2018

J reconstr Microsurg

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“…In such cases, vascularized bone grafts are an effective means for restoring integrity of the spine . In general, vascularized bone grafts are superior to nonvascular bone grafts because they provide faster healing times, diminished bone remodeling, increased bone mass, and a maintenance of structural integrity . These grafts because of their vascular nature are more resistant to infection.…”

Section: Discussionmentioning

confidence: 99%

Spinal reconstruction for osteomyelitis with free vascularized fibular grafts using intra‐abdominal recipient vessels: A series of three cases

Aliano¹,

Agulnick²,

Cohen

et al. 2013

Microsurgery

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Reconstruction of bony defects in the surgical management of vertebral osteomyelitis is a challenging endeavor. Our objective is to report the use of intra-abdominal vessels as the recipient vessels for microanastomosis of vascularized bone graft and the use of a spinal cage for fixation. Three patients failed conservative treatment for vertebral osteomyelitis and suffered pathologic fracture. Their treatment consisted of staged posterior irrigation and debridement with segmental fixation, followed by a thoracoabdominal approach multiple-level corpectomy. Reconstruction was performed with a free vascularized fibular graft placed within a custom, expandable cage. The vascularized fibular graft was anastomosed to an intra-abdominal recipient vessel. All patients improved clinically with no neurologic deficits noted. All showed evidence of successful fusion. Free vascularized bone grafts continue to be an excellent option for multi-level spinal defects related to osteomyelitis. Intra-abdominal recipient vessels are appropriate recipient vessels, as their diameter, length, and accessibility allow vascularized bone graft reconstruction of vertebral column defects of the thoracolumbar region. These vessels are also easily accessible and the anastomoses can be performed in the superficial operating incision.

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“…Thus, incorporation of vascularized bone grafts maintains structural stability, reduces infection rates, and accelerates graft consolidation. 20 Careful dissection and preservation of the vascular pedicles during rotation and implantation avoids microsurgical anastomosis and interpositional vascular grafts. This technique eliminates both the need for microsurgery and the risks of failed anastomosis or thrombosis.…”

Section: Use Of Autologous Vascularized Bone Grafts and Creation Of Tmentioning

confidence: 99%

Creation of false pedicles and a neo-pelvis for lumbopelvic reconstruction following en bloc resection of an iliosacral chondrosarcoma with lumbar spine extension

Mendel

Nathoo

Schmidt

et al. 2014

SPI

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En bloc resection with negative tumor margins remains the principal treatment option for control or cure of primary pelvic chondrosarcomas, as current adjuvant therapies remain ineffective. Iliosacral chondrosarcomas with involvement of the sciatic notch are sufficiently challenging tumors. However, when there is concomitant lumbar extension requiring resection of the pedicles to maintain negative surgical margins, transpedicular screw fixation is not possible, making reconstruction of the lumbopelvic junction extremely challenging. A patient with an iliosacral chondrosarcoma with lumbar spine extension is presented in this report to illustrate a novel lumbopelvic spinal construct. Following combined external pelvectomy and hemisacrectomy with contralateral L3–5 hemilaminectomy and ipsilateral pediculotomy, bicortical transvertebral body screws were substituted for the missing pedicles, resulting in the creation of “false pedicles,” which were further supplemented with an autologous vascularized fibular strut graft from the amputated lower limb and applied to the lateral aspect of the vertebral bodies. The creation of false pedicles allowed for a robust reconstruction of the lumbopelvic junction, including maintaining pelvic ring integrity with a “neo-pelvis”, creating a functional load-bearing construct adequate for early mobilization and ambulation. The biomechanical dynamics of this unique construct are also discussed.

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The Role of Vascularized Bone Grafts in Spine Surgery

Cited by 35 publications

References 57 publications

Vascularized Bone Grafting for Reconstruction of Oncologic Defects in the Spine: A Systematic Review and Pooled Analysis of the Literature

Vascularized Bone Grafting for Reconstruction of Oncologic Defects in the Spine: A Systematic Review and Pooled Analysis of the Literature

Spinal reconstruction for osteomyelitis with free vascularized fibular grafts using intra‐abdominal recipient vessels: A series of three cases

Creation of false pedicles and a neo-pelvis for lumbopelvic reconstruction following en bloc resection of an iliosacral chondrosarcoma with lumbar spine extension

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