Free vascularized fibular strut graft in the treatment of kyphosis

Anterior free vascularized fibular strut grafts were performed in four patients with structural kyphosis, whose curves were: 40 degrees (C3-C7) in a case of Larsen syndrome; 51 degrees (C6-T3) in a postlaminectomy kyphosis; 48 degrees (T9-L2) in a neurofibromatosis; and 125 degrees (T11-L4) in an old tuberculous spondylitis. Bony union at both fibular ends occurred mostly at 12 weeks postoperative. Vascular patency was evaluated by scintigram using 99m TcMDP. All patients showed positive uptake in the shape of the grafted fibula at 1, 3, and 8 weeks postoperative. Without exception, serial roentgenograms demonstrated rapid incorporation of the graft into the vertebral bodies, without any phase of creeping substitution. This method provides stable and long-standing anterior struts, essential in the management of high grades of kyphosis.