Results of vascularized rib grafts in complex spinal reconstruction

Jessica A. Wilden, Steven Lawrence Moran, Mark B. Dekutoski, Allen Thorp Bishop, Alexander Yong-Shik Shin

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: The application of vascularized rib grafts in spine surgery has been limited to the treatment of kyphosis with anterior placement of the rib graft to facilitate anterior spine arthrodesis. The outcomes following use of vascularized rib grafts in complex spinal reconstruction have not been adequately evaluated. The purpose of this study was to determine the results, including the time to osseous union and complications, following anterior or posterior placement of pedicled vascularized rib grafts for complex spinal reconstruction. Methods: The medical records and images of all patients in whom a vascularized rib graft had been used for a multisegmental spine reconstruction at a single institution between 1994 and 2004 were retrospectively reviewed. Eighteen patients (mean age, 45.3 years) who had been followed for an average of 31.8 months were identified. Details regarding indications, the levels that were spanned, the graft length, the time to union, and complications were evaluated. Results: The preoperative diagnoses included metastatic or primary tumor (thirteen patients) and progressive kyphosis secondary to chronic osteomyelitis (two), injury (one), congenital anomalies (one), or implant failure (one). On the average, 4.4 levels were fused and 1.9 vertebral bodies were excised. All eighteen arthrodeses included various forms of allograft and/or autograft material, and instrumentation was used, in addition to the vascularized rib graft, in twelve patients. The mean rib length was 16.1 cm, and a rib between the fifth and eleventh ribs, inclusive, was used, depending on the location of the spinal reconstruction. The average time to union was 6.8 months, and all rib grafts united. There were no complications specific to the rib-harvesting procedure. Conclusions: The use of a vascularized rib graft in complex spinal reconstruction adds little time to the overall procedure, is associated with low morbidity, and appears to offer substantial benefits to the patient. Level of Evidence: Therapeutic Level IV.

Original languageEnglish (US)
Pages (from-to)832-839
Number of pages8
JournalJournal of Bone and Joint Surgery - Series A
Volume88
Issue number4
DOIs
StatePublished - Apr 2006

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Ribs
Transplants
Kyphosis
Spine
Arthrodesis
Autografts
Osteomyelitis
Medical Records
Allografts
Morbidity

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Results of vascularized rib grafts in complex spinal reconstruction. / Wilden, Jessica A.; Moran, Steven Lawrence; Dekutoski, Mark B.; Bishop, Allen Thorp; Shin, Alexander Yong-Shik.

In: Journal of Bone and Joint Surgery - Series A, Vol. 88, No. 4, 04.2006, p. 832-839.

Research output: Contribution to journalArticle

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abstract = "Background: The application of vascularized rib grafts in spine surgery has been limited to the treatment of kyphosis with anterior placement of the rib graft to facilitate anterior spine arthrodesis. The outcomes following use of vascularized rib grafts in complex spinal reconstruction have not been adequately evaluated. The purpose of this study was to determine the results, including the time to osseous union and complications, following anterior or posterior placement of pedicled vascularized rib grafts for complex spinal reconstruction. Methods: The medical records and images of all patients in whom a vascularized rib graft had been used for a multisegmental spine reconstruction at a single institution between 1994 and 2004 were retrospectively reviewed. Eighteen patients (mean age, 45.3 years) who had been followed for an average of 31.8 months were identified. Details regarding indications, the levels that were spanned, the graft length, the time to union, and complications were evaluated. Results: The preoperative diagnoses included metastatic or primary tumor (thirteen patients) and progressive kyphosis secondary to chronic osteomyelitis (two), injury (one), congenital anomalies (one), or implant failure (one). On the average, 4.4 levels were fused and 1.9 vertebral bodies were excised. All eighteen arthrodeses included various forms of allograft and/or autograft material, and instrumentation was used, in addition to the vascularized rib graft, in twelve patients. The mean rib length was 16.1 cm, and a rib between the fifth and eleventh ribs, inclusive, was used, depending on the location of the spinal reconstruction. The average time to union was 6.8 months, and all rib grafts united. There were no complications specific to the rib-harvesting procedure. Conclusions: The use of a vascularized rib graft in complex spinal reconstruction adds little time to the overall procedure, is associated with low morbidity, and appears to offer substantial benefits to the patient. Level of Evidence: Therapeutic Level IV.",
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