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

Study Design. A case series of spinal arthrodesis performed with vasculariz ed fibular grafts is presented. Objectives. The use of vascularized fibular grafts to obtain anterior spina l fusion in patients with complex spinal disorders and poor fusion environm ents is described. Summary of Background Data. The fusion success of spinal arthrodesis is dep endent on numerous factors, such as the substrate used for arthrodesis (i.e ., graft), the biology of the fusion bed, and local host factors. Vasculari zed grafts have higher success rates for union and can better overcome a po or fusion bed than nonvascular grafts, However, they are associated with hi gher donor site morbidity and greater technical difficulty. Methods. Three patients with complex medical histories portending a difficu lt spinal fusion were treated with anterior arthrodesis using vascularized fibular autografts. Vascular patency was confirmed by bone scintigraphy, an d osseous union by radiography and computed tomography. Results. All patients had successful osseous fusion in 3 to 6 months. Defor mity was improved. Patients reported decreased pain and resumption to previ ous activities at 24 months follow-up. There were no complications. Conclusions. A vascularized fibular graft is a useful alternative to standa rd grafts for spinal arthrodesis. Vascularized fibular grafts provide high fusion rates, rapid incorporation, and increased mechanical strength, and t hus heal better in a suboptimal graft bed. The procedure is technically dem anding, often requiring the expertise of a microvascular surgeon for obtain ing the graft and achieving anastomosis. It is best suited in cases where s ignificant difficulty in obtaining a spinal fusion is anticipated.