Salvage reconstruction with vascularized fibular strut graft fusion using posterior approach in the treatment of severe spondylolisthesis

Study Design. One case is reported in which a failed anterior fusion for Gr ade 4 spondylolisthesis was treated with a vascularized fibular strut graft using a posterior approach. Objectives. To demonstrate the applicability of this technique for salvage cases or patients with systemic conditions that may decrease the success of more standard techniques. Summary of Background Data. Surgical stabilization of spondylolisthesis thr ough posterior approach with a fibular strut graft has been previously desc ribed. A vascularized strut graft can be used in the treatment of spondylol isthesis and may have applicability in those patients with underlying disea se that may impair the use of more standard techniques or in salvage recons truction. Methods. With the patient under general anesthesia, through a posterior app roach S1 and L4 were decompressed. The fibula with its vascularity intact w as harvested and anastomosed with the superior gluteal artery and vein. The fibular strut was placed into the space formed by reaming between L5 and S 1. Ilial autograft was used to augment the posterior fusion. After the proc edure 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 s lip. Conclusion. A vascularized fibular strut graft is a feasible alternative in the treatment of severe spondylolisthesis. No complications were encounter ed in the involved patient. Future application may include salvage reconstr uction of failed arthrodesis or in individuals with systemic conditions tha t may impair graft incorporation using more standard techniques.