The Journal of Bone and Joint Surgery (American). 2007;89:128-141.
doi:10.2106/JBJS.F.01282
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Results of Vascularized Rib Grafts in Complex Spinal Reconstruction

Surgical Technique

Jessica A. Wilden, MD1, Steven L. Moran, MD2, Mark B. Dekutoski, MD2, Allen T. Bishop, MD2 and Alexander Y. Shin, MD2

1 Department of Neurosurgery, University of Pennsylvania, Silverstein Building 3, 3400 Spruce Street, Philadelphia, PA 19104
2 Division of Plastic Surgery (S.L.M.), Division of Hand Surgery, Department of Surgery (S.L.M., A.T.B., and A.Y.S.), Department of Orthopedic Surgery (S.L.M., M.B.D., A.T.B., and A.Y.S.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905

Investigation performed at the Mayo Clinic, Rochester, Minnesota

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 88-A, pp. 832-839, April 2006

DISCLOSURE: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The line drawings in this article are the work of Jennifer Fairman (jfairman{at}fairmanstudios.com).

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.


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Related articles in JBJS:

Results of Vascularized Rib Grafts in Complex Spinal Reconstruction
Jessica A. Wilden, Steven L. Moran, Mark B. Dekutoski, Allen T. Bishop, and Alexander Y. Shin
JBJS 2006 88: 832-839. [Abstract] [Full Text]