title: Salvage reconstruction with vascularized fibular strut graft fusion using posterior approach in the treatment of severe spondylolisthesis.
abstract: METHODS
  One case is reported in which a failed anterior fusion for Grade 4 spondylolisthesis was treated with a vascularized fibular strut graft using a posterior approach.
  
  
  OBJECTIVE
  To demonstrate the applicability of this technique for salvage cases or patients with systemic conditions that may decrease the success of more standard techniques.
  
  
  BACKGROUND
  Surgical stabilization of spondylolisthesis through posterior approach with a fibular strut graft has been previously described. A vascularized strut graft can be used in the treatment of spondylolisthesis and may have applicability in those patients with underlying disease that may impair the use of more standard techniques or in salvage reconstruction.
  
  
  METHODS
  With the patient under general anesthesia, through a posterior approach S1 and L4 were decompressed. The fibula with its vascularity intact was harvested and anastomosed with the superior gluteal artery and vein. The fibular strut was placed into the space formed by reaming between L5 and S1. Ilial autograft was used to augment the posterior fusion. After the procedure the patient was placed in a hip spica cast.
  
  
  RESULTS
  At the 2-year follow-up the patient has incorporation of the graft, with no evidence of fracture and no significant progression of anterior slip.
  
  
  CONCLUSIONS
  A vascularized fibular strut graft is a feasible alternative in the treatment of severe spondylolisthesis. No complications were encountered in the involved patient. Future application may include salvage reconstruction of failed arthrodesis or in individuals with systemic conditions that may impair graft incorporation using more standard techniques.
authors.affiliation: Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Meyers
authors.forename: K J
authors.initials: KJ
authors.lastname: Noonan
authors.forename: A D
authors.initials: AD
authors.lastname: Mih
authors.forename: R
authors.initials: R
authors.lastname: Idler
mesh_terms: D016025:Bone Transplantation / Q000379:methods*; D002675:Child, Preschool; D005260:Female; D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000601:surgery; D008279:Magnetic Resonance Imaging; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012447:Sacrum / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013168:Spondylolisthesis / Q000601:surgery*; D016896:Treatment Outcome