Use of folded vascularized rib graft in anterior fusion after treatment of thoracic and upper lumbar lesions

Abstract

<jats:p content-type="fine-print">✓ For lesions involving the anterior and/or middle column of the spine, an anterior approach is adequate for curetting the lesion and restoring spinal stability. Materials such as autogenous bone grafts, cages with bone chips, some artificial materials, or allografts are used as strut materials. Rib material is usually removed when the anterior approach is conducted for thoracic or thoracolumbar lesions. A rib itself is not rigid enough to support the load, and a bone union is not easily obtained. The purpose of this paper is to describe a method of grafting vascularized rib in folded form to fill the defects left after removal of a spinal lesion.</jats:p> <jats:p content-type="fine-print">The rib, with the artery and vein at two levels cranial to the involved vertebral body, was isolated from surrounding tissues such as the intercostal nerve, muscles, and pleura. After curetting the lesion, the rib was folded into three or four pieces to a length adequate to fill the defect and inserted as a pedicled vascularized graft.</jats:p> <jats:p content-type="fine-print">A total of 23 cases, including 14 men and nine women, underwent surgery in which this grafting technique was used. The pathological conditions requiring anterior decompression and fusion were spinal trauma in nine cases, spinal infection in six cases, osteoporotic fracture in seven cases, and spinal metastasis in one case. In all cases a solid bone union was obtained and all infections resolved.</jats:p> <jats:p content-type="fine-print">With vascularized rib graft folded into three to four pieces, solid bone union can be obtained without use of any other grafted materials even in cases of infection and osteoporosis.</jats:p>

Repair of long intercalated rib defects using porous beta-tricalcium phosphate cylinders containing recombinant human bone morphogenetic protein-2 in dogs

“…Additionally, the harvesting of bone for grafting in situations such as spinal fusion also leads to rib defects [2]. Currently, rib defects are left unrepaired because they have little impact on respiratory function and there is no clear robust method for rib regeneration.…”

Comparative study of fibrin and chemical synthetic sealant on dural regeneration and brain damage

“…The lack of blood supply or inflammatory cell infiltration into the artificial PEG hydrogel may have contributed to its poor performance in this respect. 11,13 In addition, antibiotics administered to treat a patient may be rendered ineffective because of this reduced blood supply. Therefore, although a previous study found that PEG hydrogel sealant did not directly damage the brain parenchyma, 14 the present study indicated that it may cause cortical damage indirectly via granuloma formation on the brain surface.…”

Anterior Thoracic Spine Reconstruction Using a Titanium Mesh Cage and Pedicled Rib Flap

“…27,30,31 McBride and Bradford 27 used an additional structural cortical allograft spacer in their early series. In 1999, Deen et al 30 reported their experience placing a titanium mesh cage and pedicled rib flap adjacent to one another to fill corpectomy defects in 3 patients: 2 with osteomyelitis and 1 with plasmacytoma.…”