Vascularized Bone Grafts for Spinal Fusion—Part 2: The Rib

BACKGROUND Pseudoarthrosis, or failure to achieve bony union, is a well-known complication of spinal fusion operations. Rates range from 5% to 40% and are influenced by both patient and technical factors. Patients who do not achieve complete fusion may experience a return or worsening of their preoperative pain. For patients with complicated pathologies, vascularized bone grafts (VBGs) have been shown to provide better outcomes than nonvascularized bone grafts (N-VBGs). OBJECTIVE To enhance an instrumented spinal fusion by the innovative technique presented herein that utilizes a rotated, pedicled VBG from the left eighth rib under the paraspinous musculature into the midlumbar posterolateral gutter. METHODS For posterior approaches, the rib can be easily accessed and rotated into the appropriate strut position. The rib is dissected out, identifying and preserving the neurovascular bundle medially. The rib is then tunneled medially and appropriately positioned as the spinal graft, with the curve providing anatomic kyphosis or lordosis, depending on the surgical location. It is then successfully fixated with plates and spinal screws. RESULTS In our limited experience to date, vascularized rib grafting procedures augment fusion and reduce operating room time and bleeding compared to free flap procedures. No patients have experienced complications related to these grafts. CONCLUSION Pedicled vascularized rib grafts can be utilized to provide the advantages of a vascularized bone flap in complicated pathologies requiring spinal fusion as far as the L2-L3 level, without the morbidity associated with free tissue transfer.

Vascularized Rib Bone Grafting: Indications, Techniques, and Clinical Outcomes

Pseudarthrosis is a difficult complication often seen in patients with complex spinal pathology. To supplement existing neurosurgical approaches to cervicothoracic spinal instrumentation and fusion, novel vascularized rib bone grafts can be utilized in patients at high risk for failed spinal fusion. In this article, we discuss the indications, benefits, surgical technique, feasibility, and limitations of using rib vascularized rib bone grafts to augment spinal fusion.

MANDIBULAR RECONSTRUCTION WITH FREE NON-VASCULARIZED RIB AUTOGRAFT

Purpose of the study. To increase the effectiveness of rehabilitation of patients with acquired bone defects of the mandible with the help of rib free non-vascularized autografts. Materials and methods. In the maxillofacial department of Municipal non-profit enterprise «City Clinical Hospital for Emergency and Medical Care, Zaporizhyzhya» Council 41 patients were treated, who underwent surgical treatment to replace the acquired bone defects of the mandible with rib free autografts on the basis of the clinic of maxillofacial surgery of the State Institution SE «Zaporizhzhya Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine» 2015–2019. Most patients were of working age: from 21 to 60 years. In general, the age composition of patients was almost identical, which allowed us to assume that all studies were conducted under the same conditions and in a standard sample. Depending on etiology, surgery – replacement of mandibular defects, performed simultaneously or across a long time period. Results. Improved technique of mandibular bone grafting by free rib autograft due to the expansion of the technical possibility to reliably fix bone fragments with titanium plates and screws, as well as tight installation of the autograft in the bone defect and create, consequently, favorable conditions for a pseudo-temporal-mandibular joint formation. The own technique of preparation and formation of a costal autograft is offered. For 15 years, no complications were detected and no rejection of freely transplanted costal autografts was observed. Conclusions. The use of reliable fixation of bone fragments ensures the formation of callus and prevents autograft rejection. The proposed method of preparation of a costal autograft with a fragment of cartilage, allows to achieve reliably forming a pseudo-temporal-mandibular joint. Keywords: bone plastic, defect of the mandible, non-vascularized rib autograft, regenerative processes.