Free Vascularized Fibular Strut Autografts to the Lumbar Spine in Complex Revision Surgery: A Report of Two Cases

Abstract

This case report presents two patients who underwent fibular strut grafting for complex revisions of previous lumbar spine arthrodeses. A case review of the Electronic Medical Record at the index institution was performed to evaluate the timeline of events of the two patients who underwent fibular strut grafting for complex revisions of previous lumbar spine arthrodesis, including imaging studies, progress notes, and laboratory results. One patient had developed chronic L3 vertebral body osteomyelitis from a prior fibular allograft and instrumentation placed for a traumatic burst fracture. The second patient had a severe scoliosis recalcitrant to prior arthrodeses in the context of Marfan syndrome and a persistent L4-5 pseudarthrosis. Both patients underwent free vascularized fibular autograft revision arthrodeses. At most recent long-term follow-up, both patients had improved clinically and neither had required further revision. The use of free vascularized fibular grafting is an excellent option for a variety of spinal indications, and these two reports indicate that the technology may have an indication for use after multiple failed surgeries for osteomyelitis or correction of a multi-level large spinal deformity secondary to Marfan syndrome.

Donor Site Morbidity as a Problem of Spinal Surgery: Systematic Review

“…В хирургии позвоночника в качестве аутогенного костного материала применяются свободные, то есть лишенные естественных источников кровоснабжения, трансплантаты из местной костной ткани [45], гребня подвздошной кости, ребра, малоберцовой [31] и большеберцовой [66] костей. В качестве альтернативного источника пластического материала рассматриваются рукоятка грудины [41,62] и трансплантат из тела прилежащего позвонка [7,53].…”