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. 2016 May;6(3):212-9.
doi: 10.1055/s-0035-1558653. Epub 2015 Jul 17.

Anterior Cervical Reconstruction Using Free Vascularized Fibular Graft after Cervical Corpectomy

Ahmad Ibraheem Addosooki  1 , Mohamed Alam-Eldin  1 , Mohamed El-Sayed Abdel-Wanis  1 , Mohamed Abdelhamid Ali Yousef  2 , Paolo Dionigi  3 , Mohamed Omar Kenawey  1
Affiliations

Anterior Cervical Reconstruction Using Free Vascularized Fibular Graft after Cervical Corpectomy

Ahmad Ibraheem Addosooki et al. Global Spine J. 2016 May.

Abstract

Study Design Prospective study. Objective The aim of this study was to evaluate the clinical and radiologic results of using free vascularized fibular graft (FVFG) for anterior reconstruction of the cervical spine following with varying levels of corpectomy. Methods Ten patients underwent anterior cervical reconstruction using an FVFG after cervical corpectomy augmented with internal instrumentation. All patients were evaluated neurologically according to the Japanese Orthopaedic Association (JOA) and modified JOA scoring systems and the Nurick grading system. The neurologic recovery rate was determined, and the clinical outcome was assessed based on three factors: neck pain, dependence on pain medication, and ability to return to work. The fusion status and maintenance of lordotic correction by the strut graft were determined by measuring the lordosis angle and fused segment height (FSH). Results All patients achieved successful fusion. The mean follow-up period was 35.2 months (range, 28 to 44 months). Graft union occurred at a mean of 3.5 months. The mean loss of lordotic correction was 0.95 degrees, and the mean change in FSH was <1 mm. The neurologic recovery rate was excellent in four patients, good in five, and fair in one. All patients achieved satisfactory clinical outcome. No neurologic injuries occurred during the operations. Conclusion The use of FVFG is a valuable and effective technique in anterior cervical reconstruction for complex disorders.

Keywords: cervical corpectomy; cervical fusion; free vascularized fibular graft; microsurgical reconstruction.

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Conflict of interest statement

Disclosures Ahmad Ibraheem Addosooki, none Mohamed Alam-Eldin, none Mohamed El-Sayed Abdel-Wanis, none Mohamed Abdelhamid Ali Yousef, none Paolo Dionigi, none Mohamed Omar Kenawey, none

Figures

Fig. 1
Fig. 1
Intraoperative view of the corpectomy defect with the black arrow pointing to the site of division of the posterior longitudinal ligament.
Fig. 2
Fig. 2
Harvested free fibular graft after being shaped to match the defect size.
Fig. 3
Fig. 3
Plain X-ray lateral extension and flexion views showing solid fusion extending from C4 to C7.
Fig. 4
Fig. 4
Measurement of the fused segment height: calculated as the mean of AB (height of the anterior border) and CD (height of the posterior border).
Fig. 5
Fig. 5
(a) Preoperative X-ray; (b, c) preoperative magnetic resonance imaging (T2 and T1); (d) immediately postoperative X-rays; (e) final follow up X-rays showing solid fusion of the graft.
Fig. 6
Fig. 6
Preoperative and postoperative mean of neurologic scores. Abbreviation: JOA, Japanese Orthopaedic Association.
See this image and copyright information in PMC

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