Free vascularized bone graft in spinal surgery: indications and outcome in eight cases

In selected spinal deformities the use of a vascularized graft to establish fusion may be considered: compared to a non-vascularized graft it has superior mechanical properties, resulting in greater graft strength and stiffness, and greater effectiveness in facilitating union. Eight patients with a progressive spinal deformity (four cases) and malignancy (four cases) were treated with resection and/or correction and stabilization. To facilitate (multi)level fusion vascularized fibular grafts were used in two cervical and two thoracolumbar deformities. Fibular (two cases) or iliac grafts (two cases) were used in four cases of spinal reconstruction after vertebrectomy for malignancy. In all patients complete incorporation of the graft was obtained within 5 weeks to 8 months postoperatively. Complications occurred in three cases: one patient had a transient laryngeal edema and laryngeal nerve palsy. Another patient had a non-fatal deep vein thrombosis with pulmonary embolisms, successfully treated with anticoagulants. A third patient developed a lung infection and subsequently a deep infection around the dorsal instrumentation; after hardware removal the infection was controlled. At the latest follow-up (mean 30 months, range 24-48 months) six out of eight patients are alive. One patient died 2.5 years after the intervention due to widespread metastases, while another patient died in the postoperative period due to unknown reasons. Vascularized bone graft in spinal surgery facilitates primary mechanical stability and rapid fusion, and it has higher resistance to infection. The variety of applications of a vascularized graft may extend the range of indications for the use of grafts in spinal surgery.