Spino-plastic surgery: A literature review of vascularized bone grafts and their uses in spine reconstruction

Jeger, Jonathan L.; Simoni, Alec; Shvedova, Maria; Rebecca, Alanna; Winocour, Sebastian; Kalani, Maziyar A.; Bohl, Michael; Ropper, Alexander E.; Reece, Edward M.

doi:10.1016/j.orthop.2023.09.003

Cited by 4 publications

(6 citation statements)

References 21 publications

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“…7 Pedicled VBGs possess robust blood supply and reduce morbidity and operative time associated with free tissue transfer and avoid additional skin incisions. 4 Although there are no absolute contraindications specific to pedicled VBGs compared with free bone flaps, relative common contraindications include chronic infections, diabetes, immunosuppression, substance abuse, previous surgery or irradiation at the harvest site, and inadequate soft-tissue coverage. 8,9 However, because most of the relative contraindications are also the risk factors for pseudoarthrosis, the use of pedicled VBGs can be justified and necessary in high-risk patients when step-up approach is needed.…”

Section: Discussionmentioning

confidence: 99%

Section: Overviewmentioning

confidence: 99%

“…Vascularized bone flaps deliver blood to the donor site, improving fusion rates and decreasing infection risk and healing time, and are indicated in cases of postoperative complications or complex comorbidities. 4 Historically, free bone transfer has been used; however, free flaps are associated with substantial complications and donor-site morbidity, and require a microsurgical approach with significant added operative time. 5 A new rung to the reconstructive ladder has been developed with the use of pedicled vascularized bone grafts (VBGs) that receive blood supply from periosteal feeding vessels running in Sharpey’s fibers, with rib-VBG (R-VBG) being implemented first.…”

Section: Overviewmentioning

confidence: 99%

“…The approach using pedicled VBGs continues to evolve with recent development of techniques involving occipital, clavicular, scapular, spinous process, iliac crest, and posterior element VBGs. 4 Here, we demonstrate versatility and potential of pedicled VBGs, presenting the first bilateral R-VBG and iliac crest-VBG (IC-VBG) spinoplastic surgery performed to augment spinal fusion in a high-risk older patient with history of multiple unsuccessful spinal operations.…”

mentioning

confidence: 95%

“…3 For some patients, nonvascularized bone grafts (N-VBGs) are an appropriate option; however, in complicated cases, N-VBGs alone are not sufficient because they carry high failure rates due to intrinsic demand for healthy, vascularized tissue to promote creeping substitution and autogenous bone development. 4 Vascularized bone flaps deliver blood to the donor site, improving fusion rates and decreasing infection risk and healing time, and are indicated in cases of postoperative complications or complex comorbidities. 4 Historically, free bone transfer has been used; however, free flaps are…”

mentioning

confidence: 99%

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Novel Approach to Difficult Spinal Reconstruction: Bilateral Simultaneous Rib and Iliac Crest Vascularized Bone Graft Spinoplastic Surgery

Shvedova,

Abdulwadood,

Vernik

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Summary: Pseudoarthrosis is a severe complication of spinal fusion surgery with occurrence rates as high as 35%–40%. Current options of revision surgery to correct pseudoarthrosis frequently carry high failure rates and risk of developing junctional kyphosis. Pedicled vascularized bone grafts (VBGs) are an innovative approach to boost spinal fusion rates via improving structural integrity and increasing the delivery of blood to the donor site. This versatile technique can be performed at different spinal levels without additional skin incisions and with minimal added operative time. Here we present the first bilateral rib and iliac crest VBG spinoplastic surgery performed to augment spinal fusion in a 68-year-old woman with distal junctional kyphosis and severe positive sagittal balance with low back and neck pain and significant difficulty standing upright. The patient had history of multiple spinal operations with preoperative CT imaging demonstrating loosening and pull out of L3 and fracture of L2 screws. She underwent two-stage surgical treatment involving anterior lumbar interbody fusion L3-S1 followed by removal of hardware, T4 to pelvis fusion with L2-3 prone lateral interbody fusion, and T11-S1 posterior column osteotomies. The surgery was augmented by bilateral rib and iliac crest VBGs performed by plastic surgery. At three-month follow-up the patient demonstrated functional improvement, being able to maintain upright posture and walk; was satisfied with the result of the surgery; and demonstrated no graft-related complications. In conclusion, utilization of pedicled VBGs is a novel, promising approach to augment spinal surgery in high risk patients.

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Section: Discussionmentioning

confidence: 99%

Section: Overviewmentioning

confidence: 99%

Section: Overviewmentioning

confidence: 99%

mentioning

confidence: 95%

mentioning

confidence: 99%

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Novel Approach to Difficult Spinal Reconstruction: Bilateral Simultaneous Rib and Iliac Crest Vascularized Bone Graft Spinoplastic Surgery

Shvedova,

Abdulwadood,

Vernik

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Spino-plastic surgery

Martinez,

Abdulwadood,

Gomez

et al. 2024

Orthoplastic Surgery

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Occipital Vascularized Bone Graft for Reconstruction of a C3-C7 Defect

Riasa,

Reece,

Mahadewa

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Summary: The number of spinal reconstruction cases is growing, as are the accompanying complications. Wound complications after spinal reconstruction can be fatal and can affect up to 19% of patients undergoing major spine surgery. The discipline of spinoplastic surgery is characterized by the use of vascularized bone grafts to reconstruct spinal defects, which provide better results compared with nonvascularized and allogenic equivalents, owing to their superior blood supply. We present a 49-year-old man with spinal defect in the C3-C7 region treated with spinoplastic reconstruction. A 5 × 6 cm occipital VBG was designed with a centrally located muscular pedicle and successfully inset into the osseous defect. Radiographs taken 15 months postoperatively demonstrated overall excellent bony fusion, and the patient made an appropriate clinical recovery. In difficult spine procedures, the use of this occipital vascularized bone graft may lead to higher fusion rates without the need for free tissue transfer or allograft placement, which may not be available at all surgical centers around the world.

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Spino-plastic surgery: A literature review of vascularized bone grafts and their uses in spine reconstruction

Cited by 4 publications

References 21 publications

Novel Approach to Difficult Spinal Reconstruction: Bilateral Simultaneous Rib and Iliac Crest Vascularized Bone Graft Spinoplastic Surgery

Novel Approach to Difficult Spinal Reconstruction: Bilateral Simultaneous Rib and Iliac Crest Vascularized Bone Graft Spinoplastic Surgery

Spino-plastic surgery

Occipital Vascularized Bone Graft for Reconstruction of a C3-C7 Defect

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