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

Pedreira, Rachel; Siotos, Charalampos; Cho, Samuel K.; Seal, Stella; Bhat, Deepa; Carl, Hannah M.; Seu, Michelle; Wolinksy, Jean Paul; Sacks, Justin M.

doi:10.1055/s-0038-1642619

Cited by 11 publications

(22 citation statements)

References 57 publications

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“…Vascularized rib flaps for spinal reconstruction have been associated with a high fusion rate. 4,5,17,21,26 In a prior report from our institution (1994 to 2004), all pedicled rib flaps used to reconstruct anterior (n = 7) and posterior (n = 11) spinal defects achieved bony union, with mean time to union of 6.8 months. 5 This is consistent with our present results, which show bony union in all pedicled rib flaps, with a mean time to union of 9.1 months in the anterior pedicled rib flap group and 8.7 months in the posterior pedicled rib flap group.…”

Section: Discussionmentioning

confidence: 92%

“…Reconstruction of multilevel spondylectomy defects is imperative to restore spinal stability. 3,17 Unlike resections for palliative indications, operations for primary spinal tumors, highly selected patients with metastatic cancer, and infectious abnormalities are performed with curative intent. 3,17 The evolving multidisciplinary care for such patients necessitating neoadjuvant and adjuvant therapies may adversely affect bony union, 23,24 and with the increasing life expectancy in this patient cohort, providing durable stable arthrodesis is critical to decrease failure rates as a result of nonunion.…”

Section: Discussionmentioning

confidence: 99%

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Vascularized Bone Flap Options for Complex Thoracic Spinal Reconstruction

Asaad

Houdek

Huang

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Osseous reconstruction following total spondylectomy/vertebrectomy in the thoracic spine is indicated to restore spinal stability. To assist with bony reconstruction, vascularized bone flaps including free vascularized fibula flaps and pedicled rib flaps can be used. However, there are limited data comparing various techniques. The authors aimed to evaluate the outcomes of free vascularized fibula flaps and pedicled rib flaps used for thoracic spinal reconstruction. Methods: The authors reviewed 44 vascularized bone flaps [10 anterior pedicled rib flaps, 25 posterior pedicled rib flaps, and nine vascularized fibula flaps] for corpectomy defects spanning T1 to L1 between January of 1999 and June of 2018. Mean age and follow-up were 46 ±17 years and 74 ± 52 months, respectively. Results: The union rate was 93 percent, with a similar mean time to union among the three groups: free vascularized fibula flaps, 9 ± 4 months; anterior pedicled rib flaps, 9 ± 6 months; and posterior pedicled rib flaps, 9 ± 5 months (p = 0.95). Surgical-site complications were found in 27 vascularized bone flaps (61 percent), and reoperations and revisions were performed in 14 (32 percent) and 10 (23 percent) vascularized bone flaps, respectively. No differences were identified among anterior pedicled rib flaps, posterior pedicled rib flaps, and vascularized fibula flaps with regard to complication, reoperation, and revision rates. Conclusions: Free vascularized fibula flaps and pedicled rib flaps provide durable reconstruction for thoracic spinal defects. Union, time to union, revision, and reoperation rates were similar among anterior and posterior pedicled rib flaps and vascularized fibula flaps. Given the variability in indication and defect types among the flap cohorts, the authors’ results should be interpreted carefully as an insight into the outcomes of different vascularized bone flaps for the unique cases of thoracic spinal reconstruction rather than to compare the different flaps used. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Vascularized Bone Flap Options for Complex Thoracic Spinal Reconstruction

Asaad

Houdek

Huang

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…With the use of allografts, additional risks concern the transmission of infectious diseases and immunological reactions. Vascularized fibular or iliac bone grafts offer significant advantages, but also significant disadvantages, which include the facts that it is time-consuming, technically difficult, and comes with no guarantee of satisfactory functional results [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Thereafter, tissue engineering and the development of osteoconductive and osteoinductive matrices can provide innovative solutions for bone reconstruction [ 2 , 3 , 4 ]. However, the bone tissue engineering strategies used today are still a long way from being applied in oncology as a form of immediate post-implantation irradiation.…”

Section: Introductionmentioning

confidence: 99%

Bone Regeneration in Small and Large Segmental Bone Defect Models after Radiotherapy Using Injectable Polymer-Based Biodegradable Materials Containing Strontium-Doped Hydroxyapatite Particles

Ehret

Aid

Santos

et al. 2023

IJMS

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The reconstruction of bones following tumor excision and radiotherapy remains a challenge. Our previous study, performed using polysaccharide-based microbeads that contain hydroxyapatite, found that these have osteoconductivity and osteoinductive properties. New formulations of composite microbeads containing HA particles doped with strontium (Sr) at 8 or 50% were developed to improve their biological performance and were evaluated in ectopic sites. In the current research, we characterized the materials by phase-contrast microscopy, laser dynamic scattering particle size-measurements and phosphorus content, before their implantation into two different preclinical bone defect models in rats: the femoral condyle and the segmental bone. Eight weeks after the implantation in the femoral condyle, the histology and immunohistochemistry analyses showed that Sr-doped matrices at both 8% and 50% stimulate bone formation and vascularization. A more complex preclinical model of the irradiation procedure was then developed in rats within a critical-size bone segmental defect. In the non-irradiated sites, no significant differences between the non-doped and Sr-doped microbeads were observed in the bone regeneration. Interestingly, the Sr-doped microbeads at the 8% level of substitution outperformed the vascularization process by increasing new vessel formation in the irradiated sites. These results showed that the inclusion of strontium in the matrix-stimulated vascularization in a critical-size model of bone tissue regeneration after irradiation.

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“…Reconstruction of vertebral column defects with vascularized bone flaps increases rates of bony union, decreases the time to union, and decreases rates of complications as compared with alloplastic reconstruction using interbody cages and titanium rods. 1,2 However, reconstruction of the thoracic spine is challenging given a paucity of recipient vessels. 3 Branches of the aorta and vena cava have been described as an option but they may not be available in reoperative cases.…”

mentioning

confidence: 99%