Results of Vascularized Rib Grafts in Complex Spinal Reconstruction

Wilden, Jessica A.; Moran, Steven L.; Dekutoski, Mark B.; Bishop, Allen T.; Shin, Alexander Y.

doi:10.2106/00004623-200604000-00019

Cited by 4 publications

(13 citation statements)

References 19 publications

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“…The evidence level was III in 2 articles, 19,25 and IV in 25 studies. [7][8][9]14,16,21,22,27,31,34,35,[38][39][40][41][42]45,48,54,55,67,[69][70][71]74 The mean number of levels of tumor involvement ranged from 1 to 4.4, and 5 studies 25,34,35,54,74 did not report this information. The number of articles reporting data on primary tumors, metastatic tumors, and both, were 9, 4, and 14, respectively.…”

Section: Results Overview Of the Included Studiesmentioning

confidence: 99%

“…Thirteen studies 10,14,16,19,22,25,31,34,35,39,40,55,71 used bone grafts solely for anterior fusion, whereas two studies 41,74 solely performed posterior fusion. The other 12 studies 7,8,21,27,38,42,45,48,54,67,69,70 included patients who underwent either anterior fusion, posterior fusion, or both, and were thus substantially heterogeneous. Regarding graft options, 7 studies 16,19,39,42,55,70,71 used cages filled with morselized bone graft or other bone graft extenders, whereas 4 studies, 27,41,48,67 included patients with vascularized autogenic bone grafts either with or without vascular pedicles.…”

Section: Results Overview Of the Included Studiesmentioning

confidence: 99%

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Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis

Elder

Ishida

Goodwin

et al. 2017

FOC

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OBJECTIVE With the advent of new adjunctive therapy, the overall survival of patients harboring spinal column tumors has improved. However, there is limited knowledge regarding the optimal bone graft options following resection of spinal column tumors, due to their relative rarity and because fusion outcomes in this cohort are affected by various factors, such as radiation therapy (RT) and chemotherapy. Furthermore, bone graft options are often limited following tumor resection because the use of local bone grafts and bone morphogenetic proteins (BMPs) are usually avoided in light of microscopic infiltration of tumors into local bone and potential carcinogenicity of BMP. The objective of this study was to review and meta-analyze the relevant clinical literature to provide further clinical insight regarding bone graft options. METHODS A web-based MEDLINE search was conducted in accordance with preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines, which yielded 27 articles with 383 patients. Information on baseline characteristics, tumor histology, adjunctive treatments, reconstruction methods, bone graft options, fusion rates, and time to fusion were collected. Pooled fusion rates (PFRs) and I2 values were calculated in meta-analysis. Meta-regression analyses were also performed if each variable appeared to affect fusion outcomes. Furthermore, data on 272 individual patients were available, which were additionally reviewed and statistically analyzed. RESULTS Overall, fusion rates varied widely from 36.0% to 100.0% due to both inter- and intrastudy heterogeneity, with a PFR of 85.7% (I2 = 36.4). The studies in which cages were filled with morselized iliac crest autogenic bone graft (ICABG) and/or other bone graft options were used for anterior fusion showed a significantly higher PFR of 92.8, compared with the other studies (83.3%, p = 0.04). In per-patient analysis, anterior plus posterior fusion resulted in a higher fusion rate than anterior fusion only (98.8% vs 86.4%, p < 0.001). Although unmodifiable, RT (90.3% vs 98.6%, p = 0.03) and lumbosacral tumors (74.6% vs 97.9%, p < 0.001) were associated with lower fusion rates in univariate analysis. The mean time to fusion was 5.4 ± 1.4 months (range 3–9 months), whereas 16 of 272 patients died before the confirmation of solid fusion with a mean survival of 3.1 ± 2.1 months (range 0.5–6 months). The average time to fusion of patients who received RT and chemotherapy were significantly longer than those who did not receive these adjunctive treatments (RT: 6.1 months vs 4.3 months, p < 0.001; chemotherapy: 6.0 months vs 4.3 months, p = 0.02). CONCLUSIONS Due to inter- and intrastudy heterogeneity in patient, disease, fusion criteria, and treatment characteristics, the optimal surgical techniques and factors predictive of fusion remain unclear. Clearly, future prospective, randomized studies will be necessary to better understand the issues surrounding bone graft selection following resection of spinal column tumors.

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Section: Results Overview Of the Included Studiesmentioning

confidence: 99%

Section: Results Overview Of the Included Studiesmentioning

confidence: 99%

Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis

Elder

Ishida

Goodwin

et al. 2017

FOC

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“…In cases involving multiple level resection like ours, vascularised bone grafts prove ideal [8,10]. Theoretically, vascularised grafts should not be utilised with tumours as graft blood flow into the tumour bed could facilitate tumour cell dissemination and recurrent tumour growth, however, the risk of this occurring is low following en bloc resections [8,11]. Both vascularised fibular and rib grafts have been popularised for spine reconstruction due to their length.…”

Section: Reconstructionmentioning

confidence: 99%

“…Since the 1980s, they have been used for a growing number of spinal pathologies with placement of vascularised rib grafts anteriorly due to their curvature, being the most promoted method described in the literature [11]. There is however, a lack of literature addressing vascularised rib graft use in the posterior spine [8,11] Wilden et al's [11] study on 18 patients showed that pedicled vascularised rib grafts up to 30 cm in length could be used anteriorly or posteriorly to span up to ten levels and achieve union in an average of 6.8 months.…”

Section: Reconstructionmentioning

confidence: 99%

“…Disadvantages of free vascularised fibular grafts include increased operating times, increased blood loss and technical difficulties achieving microvascular anastomoses. Whilst operation times are significantly longer, the amount of blood loss in fibular harvest generally does not require transfusion [9,11]. Complications caused by fibular harvesting include transient peroneal nerve palsy, non-union, flap failure, infection and hematoma [10], however, these are uncommon [9].…”

Section: Reconstructionmentioning

confidence: 99%

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Extensive lumbar chordoma and unique reconstructive approach

Sivabalan

Mobbs

2011

Eur Spine J

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Chordomas are rare, malignant, low grade, primary bone tumours arising from notochord remnants. They are rarely located in the lumbar spine and consequently, the literature is lacking about the condition. There are very few case reports on the technical aspects of resection of extensive lesions such as our case. Treatment can be potentially curative only if aggressive surgical resection is utilised. We describe a case of an extensive lumbar chordoma, and demonstrate the possibility of performing a staged anterior and posterior total tumour resection with planned transgression in conjunction with an expandable cage, vascularised rib, fibula and latissimus dorsi grafts for the treatment and reconstruction of extensive spinal disease with this condition.

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