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
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. See Instructions
to Authors for a complete description of levels of evidence.