Use of vascularized fibular grafts as a salvage procedure for previously failed spinal arthrodesis

Study Design. A case series of spinal arthrodesis performed with vascularized fibular grafts is presented. Objectives. The use of vascularized fibular grafts to obtain anterior spinal fusion in patients with complex spinal disorders and poor fusion environments is described. Summary of Background Data. The fusion success of spinal arthrodesis is dependent on numerous factors, such as the substrate used for arthrodesis (i.e., graft), the biology of the fusion bed, and local host factors. Vascularized grafts have higher success rates for union and can better overcome a poor fusion bed than nonvascular grafts, However, they are associated with higher donor site morbidity and greater technical difficulty. Methods. Three patients with complex medical histories portending a difficult spinal fusion were treated with anterior arthrodesis using vascularized fibular autografts. Vascular patency was confirmed by bone scintigraphy, and osseous union by radiography and computed tomography. Results. All patients had successful osseous fusion in 3 to 6 months. Deformity was improved. Patients reported decreased pain and resumption to previous activities at 24 months follow-up. There were no complications. Conclusions. A vascularized fibular graft is a useful alternative to standard grafts for spinal arthrodesis. Vascularized fibular grafts provide high fusion rates, rapid incorporation, and increased mechanical strength, and thus heal better in a suboptimal graft bed. The procedure is technically demanding, often requiring the expertise of a microvascular surgeon for obtaining the graft and achieving anastomosis. It is best suited in cases where significant difficulty in obtaining a spinal fusion is anticipated.