Spinal reconstruction for osteomyelitis with free vascularized fibular grafts using intra‐abdominal recipient vessels: A series of three cases

Abstract

Reconstruction of bony defects in the surgical management of vertebral osteomyelitis is a challenging endeavor. Our objective is to report the use of intra-abdominal vessels as the recipient vessels for microanastomosis of vascularized bone graft and the use of a spinal cage for fixation. Three patients failed conservative treatment for vertebral osteomyelitis and suffered pathologic fracture. Their treatment consisted of staged posterior irrigation and debridement with segmental fixation, followed by a thoracoabdominal approach multiple-level corpectomy. Reconstruction was performed with a free vascularized fibular graft placed within a custom, expandable cage. The vascularized fibular graft was anastomosed to an intra-abdominal recipient vessel. All patients improved clinically with no neurologic deficits noted. All showed evidence of successful fusion. Free vascularized bone grafts continue to be an excellent option for multi-level spinal defects related to osteomyelitis. Intra-abdominal recipient vessels are appropriate recipient vessels, as their diameter, length, and accessibility allow vascularized bone graft reconstruction of vertebral column defects of the thoracolumbar region. These vessels are also easily accessible and the anastomoses can be performed in the superficial operating incision.

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

“…FVFBGs have been reported for a variety of spinal conditions including osteomyelitis, neoplasms, neurofibromatosis, and Arnold-Chiari malformations 2 3 5 6 15) . Winters et al 23) reported a case series of 30 spine patients with FVFBGs.…”

Fibula osteo-adipofascial flap for reconstruction of a cervical spine and posterior pharyngeal wall defect

“…There are different reports using the free fibula flap for reconstruction of multilevel spine defects both for anterior spinal fusion, posterior fusion, osteomyelitis, or in irradiated patients . The benefits of using a fibula flap include a consistent anatomy, relative ease of flap harvest, length of pedicle, and low donor‐site morbidity.…”

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

“…39 In spinal reconstruction, popular options include pedicled vascularized ribs, iliac crest, and, most commonly, FVFGs. 43 FVFGs rely on the peroneal artery as a donor vessel, 44 and recipient vessels vary depending on the region of reconstruction-internal thoracic vessels, lumbar segmental vessels, iliac vessels, inferior mesenteric vessels, and the aorta are common choices. 43 Advantages of the FVFG include sufficient length to cover larger defects and a larger amount of cancellous bone leading to the quick and high union rates reported.…”

“…43 FVFGs rely on the peroneal artery as a donor vessel, 44 and recipient vessels vary depending on the region of reconstruction-internal thoracic vessels, lumbar segmental vessels, iliac vessels, inferior mesenteric vessels, and the aorta are common choices. 43 Advantages of the FVFG include sufficient length to cover larger defects and a larger amount of cancellous bone leading to the quick and high union rates reported. 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.…”