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

다국어 초록 (Multilingual 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.

참고문헌 (Reference)

1 Ling XF., "What is the price to pay for a free fibula flap? A systematic review of donor-site morbidity following free fibula flap surgery" 129 : 657-674, 2012

2 Krishnan KG., "Ventral cervical fusion at multiple levels using free vascularized double-islanded fibula-a technical report and review of the relevant literature" 11 : 176-182, 2002

3 Moche JA., "Vascularized free fibula for cervical spine reconstruction following complicated retropharyngeal abscess" 145 : 178-179, 2011

4 Freidberg SR., "Vascularized fibular graft to replace resected cervical vertebral bodies. Case report" 71 : 283-286, 1989

5 Moran SL., "The use of vascularized fibular grafts for the reconstruction of spinal and sacral defects" 29 : 393-400, 2009

6 Shin AY., "The role of vascularized bone grafts in spine surgery" 38 : 61-72, 2007

7 Ackerman DB., "The results of vascularized-free fibular grafts in complex spinal reconstruction" 24 : 170-176, 2011

8 Winters HA., "Spinal reconstruction with free vascularised bone grafts; approaches and selection of acceptor vessels" 102 : 42-48, 2013

9 Aliano KA., "Spinal reconstruction for osteomyelitis with free vascularized fibular grafts using intra-abdominal recipient vessels : A series of three cases" 33 : 560-566, 2013

10 Asazuma T., "Spinal fusion using a vascularized fibular bone graft for a patient with cervical kyphosis due to neurofibromatosis" 10 : 537-540, 1997

11 Imran Y., "Skin paddle as an indicator of the viability of vascularized fibular graft" 45 : 110-112, 2004

12 Sakuraba M., "Pelvic ring reconstruction with the double-barreled vascularized fibular free flap" 116 : 1340-1345, 2005

13 Hu H., "Internal thoracic vessels used as pedicle graft for anastomosis with vascularized bone graft to reconstruct C7-T3 spinal defects : a new technique" 32 : 601-605, 2007

14 Chen ZC., "Fusion of the lumbar spine with a free vascularized fibular bone graft : case report" 21 : 463-468, 1998

15 Huang YC., "Functional assessment of donor-site morbidity after harvest of a fibula chimeric flap with a sheet of soleus muscle for mandibular composite defect reconstruction" 32 : 20-25, 2012

16 Hubbard LF., "Free vascularized fibula transfer for stabilization of the thoracolumbar spine. A case report" 10 : 891-893, 1985

17 Minami A., "Free vascularised fibular strut graft for anterior spinal fusion" 79 : 43-47, 1997

18 Sang-Hyun Sung, "Evaluation of Risk Factors for Vertebral Compression Fracture after Stereotactic Radiosurgery in Spinal Tumor Patients" 대한척추신경외과학회 11 (11): 103-108, 2014

19 Weiland A., "Current concepts review : vascularized bone autografts" 63 : 166-169, 1981

20 Nijland EA., "Correction of a dystrophic cervicothoracic spine deformity in Recklinghausen’s disease" 349 : 149-155, 1998

21 Wittenberg RH., "Compressive strength of autologous and allogenous bone grafts for thoracolumbar and cervical spine fusion" 15 : 1073-1078, 1990

22 Goldberg VM., "Biology of vascularized bone grafts" 18 : 197-205, 1987

23 de Kleuver M., "Asymptomatic massive dural ectasia associated with neurofibromatosis type 1 threatening spinal column support : treatment by anterior vascularized fibula graft" 17 : 539-542, 2004

24 Streitz W., "Anterior fibular strut grafting in the treatment of kyphosis" 128 : 140-148, 1997