Anterior Cervical Reconstruction Using Free Vascularized Fibular Graft after Cervical Corpectomy

Abstract

Study Design Prospective study. Objective The aim of this study was to evaluate the clinical and radiologic results of using free vascularized fibular graft (FVFG) for anterior reconstruction of the cervical spine following with varying levels of corpectomy. Methods Ten patients underwent anterior cervical reconstruction using an FVFG after cervical corpectomy augmented with internal instrumentation. All patients were evaluated neurologically according to the Japanese Orthopaedic Association (JOA) and modified JOA scoring systems and the Nurick grading system. The neurologic recovery rate was determined, and the clinical outcome was assessed based on three factors: neck pain, dependence on pain medication, and ability to return to work. The fusion status and maintenance of lordotic correction by the strut graft were determined by measuring the lordosis angle and fused segment height (FSH). Results All patients achieved successful fusion. The mean follow-up period was 35.2 months (range, 28 to 44 months). Graft union occurred at a mean of 3.5 months. The mean loss of lordotic correction was 0.95 degrees, and the mean change in FSH was <1 mm. The neurologic recovery rate was excellent in four patients, good in five, and fair in one. All patients achieved satisfactory clinical outcome. No neurologic injuries occurred during the operations. Conclusion The use of FVFG is a valuable and effective technique in anterior cervical reconstruction for complex disorders.

Anterior Fusion using a Vascularized Fibular Graft for Cervical Kyphosis Associated with Neurofibromatosis Type 1: A Report of Two Cases with Long-term Follow-up

“…However, free fibular grafts take a long time to achieve bone union, and Bradford et al reported that four of the 23 free fibular grafts showed fatigue fractures [ 8 ]. VFG has been used successfully for multilevel fusion [ 4 ], including anterior fusion with VFG for multilevel decompression and fusion in ossification of the posterior longitudinal ligament or severe kyphotic deformity after laminectomy [ 9 ]. VFG has also been used for fusion of the dystrophic NF-1 spine [ 1 ].…”

“…A free fibular graft requires a longer period of orthosis since bone union does not occur for a year or more [ 13 ]. Although previous reports have followed VFG for periods of 24–43 months [ 1 , 9 ], this report describes the long-term outcomes and maintenance of cervical alignment after VFG.…”

Reconstruction of complex hand defects using trapezoidal osteocutaneous free fibular flap

“…Various treatment options do exist like pedicled or free soft tissue flap and bone autograft in onestage or two-stage procedures. Revascularization of bone autograft graft takes a very long time, and resistance to infection is minimal (Addosooki et al, 2016;Weiland et al, 1984). On the other hand, the use of vascularized composite osteocutaneous flap can treat bone and soft tissue defects simultaneously and provides a vascularized bone graft that is resistant to infection (Datiashvili et al, 1992;Momeni & Stark, 2006;Tropet et al, 1995;Yazar et al, 2008).…”

“…This method prolongs treatment time and limb immobilization. Furthermore, nonvascularized bone grafts are inferior to vascularized grafts in terms of union rate, resistance to infection, mechanical strength, and scarring around the graft (Addosooki et al, 2016;El-Gammal et al, 2008;Goldberg, Shaffer, Field, & Davy, 1987;Shaffer, Field, Goldberg, & Davy, 1985;Weiland, Phillips, & Randolph, 1984).…”

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

“…45 The use of VBG in cases of tissue bed compromise (deep space infection, osteomyelitis, radiation) has been described in several reasonably sized case series. [46][47][48] Notably, Eastlack et al reported outcomes for 18 patients with vascularized pedicled rib grafts used in spinal reconstruction following osteomyelitis. 49 Even in infected tissues beds, they found the mean union time was 6.2 months with 100% of patients having a successful union and no patients experiencing complications.…”