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

Wuisman, P.; Jiya, Timothy U.; Dijk, Martijn van; Sugihara, Shinsuke; Royen, Barend J. van; Winters, H.A.H.

doi:10.1007/s005860050177

Cited by 41 publications

(31 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The use of free or pedicled vascularized bones for intervertebral interposition and stabilization has been reported [10,17,22,24,27,28]. Such flaps are found advantageous especially in secondary and/or complex reconstructions [10,24], in combined reconstruction of defects of bone and the integument [22], and in progressive spinal deformities or tumors [27].…”

Section: Discussionmentioning

confidence: 99%

“…Such flaps are found advantageous especially in secondary and/or complex reconstructions [10,24], in combined reconstruction of defects of bone and the integument [22], and in progressive spinal deformities or tumors [27]. The value of vascularized bone strut grafts in the treatment of kyphoscoliotic conditions, where much mechanical stress tolerance is required, has been emphasized [29].…”

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 later stages of healing, is superlative, and bone fusion is rapid [27]. Owing to its vitality, the vascularized bone flap is subject to hypertrophic changes under mechanical stress, and is also resistant to bacterial invasion.…”

Section: Kartik G Krishnan Adolf Müllermentioning

confidence: 99%

“…Several reconstruction techniques using vascularized bone for attaining spinal stability have been described [10,17,22,24,27,28]. These reports concentrate either on the fusion of one segment, or, when of several segments, they describe the resection of several segments en bloc (i.e., contiguous segments) and replacement using one long vascularized bone strut.…”

Section: Kartik G Krishnan Adolf Müllermentioning

confidence: 99%

See 3 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Kartik G Krishnan Adolf Müllermentioning

confidence: 99%

Section: Kartik G Krishnan Adolf Müllermentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

show abstract

“…Radiographs disclosed resorption and dislodgement of the proximal site of the fibular graft, but without signs of cage migration or loosening in the instrumented area. A second intervention through an anterior approach rather than a posterior approach was chosen: explantation of the titanium cage, correction of the deformity, stabilisation of the defect by a doublefolded vascularized fibular graft, and anterior instrumentation was performed [16]. At the time of surgery, the cage demonstrated solid anchorage on both sides, suggesting complete fusion of the spinal segment.…”

Section: Case Reportmentioning

confidence: 99%

Bone histomorphometric evaluation of a clinically fused titanium tumour cage in a child

Dijk

Smit

Burgér

et al. 2002

European Spine Journal

View full text Add to dashboard Cite

Fibula Free Flap Reconstruction of Cervical Spine Defects: A Multi‐Institutional Study

Yang,

Morton,

Colcord

et al. 2024

The Laryngoscope

View full text Add to dashboard Cite

IntroductionCervical spine defects result in spinal instability, putting the spinal cord and vertebral arteries at risk of damage and possibly devastating neurological injuries. The fibula free flap can span the spinal defects for stability. There is a paucity of literature on this technique.MethodMulti‐institutional retrospective case series reviewing patients who underwent cervical spine reconstruction with a fibula free flap. Patient demographic information, comorbidities, characteristics of cervical spine defects, and free flap complications were collected.ResultsA total of 1187 fibula free flaps across 10 different institutions were reviewed. Thirteen patients (1.09%) underwent cervical spine reconstruction with a fibula free flap. Average age was 52.3 years old with an age range of 12–79 years. There were six males (46.1%) and seven females (53.8%). The most common defect etiology was infection (n = 6, 46.1%). Most commonly involved cervical spine level of the defect was C5 (n = 10) followed by C6 (n = 9) and C4 (n = 8). The majority of reconstructed defects spanned three or more cervical levels, (n = 9, 69.2%). Facial artery was the most common arterial anastomosis (n = 8). Eight patients (61.5%) required a tracheostomy during their postoperative course. None of the patients had symptomatic or radiographic nonunion.ConclusionThis case series demonstrates that a vascularized fibula flap is a potential reconstructive option for cervical spine defects, especially in defects greater than three cervical levels, in the setting of infection, and previously radiated patients.Level of EvidenceLevel 4 Laryngoscope, 2024

show abstract

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

Cited by 41 publications

References 45 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

Bone histomorphometric evaluation of a clinically fused titanium tumour cage in a child

Fibula Free Flap Reconstruction of Cervical Spine Defects: A Multi‐Institutional Study

Contact Info

Product

Resources

About