Document Detail


The Results of Vascularized-free Fibular Grafts in Complex Spinal Reconstruction.
MedLine Citation:
PMID:  20634729     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
STUDY DESIGN: Retrospective review.
OBJECTIVE: To determine outcomes after anterior or posterior placement of vascularized-free fibular grafts in complex spinal reconstruction for tumor resection and osteomyelitis and to evaluate the results with respect to bony fusion, time to union, and complications.
SUMMARY OF BACKGROUND DATA: Biological reconstruction of segmental defects of the spinal column may be required when multiple vertebras are resected for tumor or infection. Published series to date have not fully addressed surgical techniques or outcome and complications.
METHODS: A retrospective, Institutional Review Board-approved review was performed on the medical records and neuroimaging of all patients who underwent a vascularized-free fibular graft for a multisegmental spine reconstruction at a single institution over the last 10 years. Details regarding indications, the levels spanned, the graft length, and the time to union were evaluated.
RESULTS: Seven patients (mean age, 43 y) underwent surgery using this technique, with an average follow-up of 38 months. Surgical indications included oncologic resection associated with radiation therapy (n=3) and surgical treatment of vertebral osteomyelitis (n=4). An average of 2.7 (median, 2) levels was fused with an average of 2.1 (median, 2) vertebral body excisions performed. Mean fibular length was 19.1 cm. Six of 7 patients achieved union at mean of 3.2 months. Complications specific to the fibular grafting procedure included 1 nonunion associated with pedicle thrombosis.
CONCLUSIONS: Vascularized-free fibular grafts are effective in the treatment of complex spinal reconstruction after surgery for spinal tumors or osteomyelitis. The vascularized-free fibular graft adds structural support as well as living bone to the fusion site and is a reasonable alternative to nonvascularized grafts in locally compromised surgical beds.
Authors:
Duncan B Ackerman; Peter S Rose; Steven L Moran; Mark B Dekutoski; Allen T Bishop; Alexander Y Shin
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of spinal disorders & techniques     Volume:  24     ISSN:  1539-2465     ISO Abbreviation:  J Spinal Disord Tech     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101140323     Medline TA:  J Spinal Disord Tech     Country:  United States    
Other Details:
Languages:  eng     Pagination:  170-6     Citation Subset:  IM    
Affiliation:
Department of Orthopedic Surgery and Plastic Surgery, Mayo Clinic, Rochester, MN.
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