The use of vascularized fibular grafts for the reconstruction of spinal and sacral defects

Background: Large segmental defects of the spine may result from tumor resection as well as infection. The surrounding soft tissue in these situations is often compromised due to radiation exposure or infection. In these situations, in which conventional bone grafting has often failed, we have found vascularized fibular grafts an effective method of achieving bony union. The purpose of this study was to review the results of vascularized bone grafting for complex spinal reconstruction using free fibular transfer. Methods: We performed a retrospective chart review of all patients who underwent multisegmental spinal reconstruction and pelvic reconstruction using posterior instrumentation and free fibula vascularized bone transfer. Results: Twelve patients underwent 14 free fibula transfers (7 anterior and 5 posteriorly placed) for reconstruction of lumbosacral spinal defects. Preoperative diagnoses included tumor, osteomyelitis, and nonunion. Average number of vertebral body resections was four and posterior instrumentation was used for all arthrodeses. Average duration of follow up was 45 months. Two flaps failed (14%), one resulting in nonunion and the other required salvage with an external hemipelvectomy. All remaining flaps healed at a mean time of 4.5 months (range, 3-10 months). Conclusion: Free fibula transfer for complex spinal reconstruction is a reliable means of obtaining bony union for complex lumbar or sacral resections where traditional bone grafting techniques may not be technically feasible.