title: The results of vascularized-free fibular grafts in complex spinal reconstruction.
abstract: METHODS
  Retrospective review.
  
  
  OBJECTIVE
  To determine outcomes after anterior or posterior placement of vascularized-free fibular grafts in complex spinal reconstruction for tumor resection and osteomyelitis and to evaluate the results with respect to bony fusion, time to union, and complications.
  
  
  BACKGROUND
  Biological reconstruction of segmental defects of the spinal column may be required when multiple vertebrae are resected for tumor or infection. Published series to date have not fully addressed surgical techniques or outcome and complications.
  
  
  METHODS
  A retrospective, Institutional Review Board-approved review was performed on the medical records and neuroimaging of all patients who underwent a vascularized-free fibular graft for a multisegmental spine reconstruction at a single institution over the last 10 years. Details regarding indications, the levels spanned, the graft length, and the time to union were evaluated.
  
  
  RESULTS
  Seven patients (mean age, 43 y) underwent surgery using this technique, with an average follow-up of 38 months. Surgical indications included oncologic resection associated with radiation therapy (n=3) and surgical treatment of vertebral osteomyelitis (n=4). An average of 2.7 (median, 2) levels was fused with an average of 2.1 (median, 2) vertebral body excisions performed. Mean fibular length was 19.1 cm. Six of 7 patients achieved union at mean of 3.2 months. Complications specific to the fibular grafting procedure included 1 nonunion associated with pedicle thrombosis.
  
  
  CONCLUSIONS
  Vascularized-free fibular grafts are effective in the treatment of complex spinal reconstruction after surgery for spinal tumors or osteomyelitis. The vascularized-free fibular graft adds structural support as well as living bone to the fusion site and is a reasonable alternative to nonvascularized grafts in locally compromised surgical beds.
authors.affiliation: Department of Orthopedic Surgery and Plastic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Duncan B
authors.initials: DB
authors.lastname: Ackerman
authors.forename: Peter S
authors.initials: PS
authors.lastname: Rose
authors.forename: Steven L
authors.initials: SL
authors.lastname: Moran
authors.forename: Mark B
authors.initials: MB
authors.lastname: Dekutoski
authors.forename: Allen T
authors.initials: AT
authors.lastname: Bishop
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Shin
mesh_terms: D000293:Adolescent; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005360:Fibula / Q000098:blood supply* / Q000503:physiopathology / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*