Vertebral Body Replacement with Femoral Neck Allograft and Vascularized Rib Strut Graft

McBride, G G; Bradford, David S.

doi:10.1097/00007632-198305000-00011

Cited by 38 publications

(20 citation statements)

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“…Apart from fibula, free or pedicled rib graft, iliac crest and split radial bone are some other vascularizable flaps used in vertebral reconstructions [16,19,28]. For reconstruction of a single vertebral level, vascularized iliac crest could be a suitable option, since the spongeous tissue that takes part in the initial periods of bone fusion is abundant in the iliac crest.…”

Section: Discussionmentioning

confidence: 99%

Ventral cervical fusion at multiple levels using free vascularized double-islanded fibula – a technical report and review of the relevant literature

Krishnan

Müller

2002

Eur Spine J

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IntroductionVarious methods of spinal stabilization, ranging from multiple wire fixation to complex reconstruction with vascularized bone struts, are described in the literature [21]. The choice of method depends on the specific indications posed by the clinical and morpho-physiological situation. Like any surgical method, each spinal fusion technique has its own pitfalls. Graft resorption, collapse, sequestration and pseudarthrosis formation are some of the common complications in using non-vascularized autogenous and allogenous bone grafts, especially in the old and in patients with compromised healing [7,13]. Screw loosening and plate or rod migration are some problems associated with stabilization using implants [7,8]. It has been suggested that vascularized bone flaps do not undergo resorption, and maintain twice the bone density of non-vascularized grafts [28]. The mechanical stability of vascularized bone used in spinal surgery, both initially and in Abstract Reconstruction of the cervical spine using free vascularized bone flaps has been described in the literature. The reports involve either one level or, when multiple levels, they describe en bloc resection and reconstruction. Stabilization of different levels with a preserved intermediate segment with a single vascularized flap has not been described. We report on the case of a 55-yearold man, who had been operated several times using conventional techniques for cervical myelopathy and instability, who presented to us with severe neck pain. Diagnostic procedures showed pseudarthrosis of C3/4 and stress-overload of the C3/4 and C5/6 segments. The C4/5 fusion was adequately rigid, but avascular. We performed anterior cervical fusion at the C3/4 and C5/6 levels with a vascularized fibula flap modified as a double island. The rigidly fused C4/5 block was preserved and vascularized with the periosteum bridging the two fibular islands. The method and technique are described in detail. Fusion was adequate. Donor site morbidity was minimal and temporary. The patient is symptom free to date (25 months). The suggested method provides the possibility of vertebral fusion at different levels using a single vascularized flap. The indications for this procedure are (1) repeated failure of conventional methods, (2) established poor bone healing and bone non-union with avascular grafts and (3) a well-fused or preserved intermediate segment. The relevant literature is reviewed.

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Section: Discussionmentioning

confidence: 99%

Ventral cervical fusion at multiple levels using free vascularized double-islanded fibula – a technical report and review of the relevant literature

Krishnan

Müller

2002

Eur Spine J

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“…During this period the grafted bone is weak and can fracture and there is a risk of nonunion [2,5,11,35]. This may result in deterioration of a deformity or even dislodgment of the graft [5,20,26,29,43].…”

Section: Discussionmentioning

confidence: 99%

“…A pedicle rib graft has the advantage of not necessitating vascular anastomoses; however, its application is limited. It is too weak, is oval in cross-section, curved, and has a thin cortex [16,20,26]. A vascularized fibula overcomes these disadvantages: it is retrievable in sufficient length, has no angulation, and can be used in any location of the vertebral column [41].…”

Section: Discussionmentioning

confidence: 99%

“…To facilitate fusion, autogenous bone graft is used most often and the results are well known [5,12,22,26,27]. The use of a particular type of graft (iliac, rib, fibula or a combination), however, may vary depending on location, size and type of the deformity or defect to be bridged, the type of reconstruction, and the required mechanical support.…”

Section: Introductionmentioning

confidence: 99%

“…In this respect, vascularized bone grafts may overcome some of these problems: they show faster ingrowth in the adjoining bone, minimize the extent of creeping substitution, show normal remodeling and tend to resist higher biomechanical loads [3,11,15,20]. Clinical experiences in spinal surgery using vascularized grafts underline these potential advantages [3,4,6,8,9,20,26,28,29,33].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Free vascularized bone graft in spinal surgery: indications and outcome in eight cases

Wuisman¹,

Jiya²,

Dijk³

et al. 1999

European Spine Journal

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The use of vascularized fibular grafts for the reconstruction of spinal and sacral defects

et al. 2009

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Vertebral Body Replacement with Femoral Neck Allograft and Vascularized Rib Strut Graft

Cited by 38 publications

References 0 publications

Ventral cervical fusion at multiple levels using free vascularized double-islanded fibula – a technical report and review of the relevant literature

Ventral cervical fusion at multiple levels using free vascularized double-islanded fibula – a technical report and review of the relevant literature

Free vascularized bone graft in spinal surgery: indications and outcome in eight cases

The use of vascularized fibular grafts for the reconstruction of spinal and sacral defects

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