8.0: Thursday, March 17, 2005

The Microvascular Free Fibula Transfer as a Salvage Reconstruction for Failed Anterior Spine Surgery Due to Chronic Osteomyelitis

Ricardo A. Meade, MD, Detlev Erdmann, William J. Richardson, Richard L. McCann, and L. Scott Levin, MD, FACS.

The fibular graft has become a mainstay in reconstruction of osseous defects using vascularized bone transfer. Extensive experience with this graft has led to various applications which have been instrumental in osseous reconstructive surgery, particularly of the spine. Several factors influence the osseous union of spinal fusions including substrate used for arthrodesis, biology of the fusion bed, and local host factors. While cancellous bone grafting may be useful in simple cases without major osseous defect, corticocancellous strut grafts are required if mechanical support is needed. Vascularized bone transfer provides certain advantages over conventional bone grafts in reconstruction of osseous defects greater than 6cm in length. In the spine, the size and location of defects to be reconstructed determine which type of bone graft is required. The most suitable spinal level for consolidating a microvascular free fibular graft is the cervical region. Using the free vascularized fibula graft as a rescue procedure for failed anterior spine surgery with subsequent bacterial spinal osteomyelitis has not been reported. We describe four clinical cases of spinal osteomyelitis after failed spinal fusion that were salvaged with this procedure with up to 4 years follow up. All patients resumed previous work activities and expressed satisfaction postoperatively.