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Anterior Cervical Reconstruction Using Free Vascularized Fibular Graft after Cervical Corpectomy.

Addosooki AI, Alam-Eldin M, Abdel-Wanis Mel-S, Yousef MA, Dionigi P, Kenawey MO - Global Spine J (2015)

Bottom Line: Results All patients achieved successful fusion.All patients achieved satisfactory clinical outcome.No neurologic injuries occurred during the operations.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Sohag University Hospital, Sohag, Egypt.

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.

No MeSH data available.


Related in: MedlinePlus

Intraoperative view of the corpectomy defect with the black arrow pointing to the site of division of the posterior longitudinal ligament.
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FI1500032-1: Intraoperative view of the corpectomy defect with the black arrow pointing to the site of division of the posterior longitudinal ligament.

Mentions: Two surgical teams operated simultaneously. We used the Smith-Robinson anterior cervical approach for corpectomy (Fig. 1) and a lateral approach to harvest the fibular graft.11 The skin was incised vertically to facilitate the dissection of the recipient vessels and graft placement. After incising the skin and platysma muscle, the dissection was continued carefully to prepare a superficial recipient vein (branch of the external jugular veins). Superficial veins are better than deep venae comitantes because they have larger diameters, thicker walls, and better drainage. Furthermore, anastomosis is much easier because it is carried superficially in a wide field. The pretracheal fascia was sharply incised medially to the carotid sheath. Based on the levels affected, either the superior thyroid artery or lingual artery was dissected gently and prepared as a recipient vessel. The prepared recipient vessel was well protected throughout the remainder of the procedure. We performed diskectomy followed by corpectomy at the desired levels until removal of the posterior longitudinal ligament, exposure of the dura, and complete decompression of the spinal cord were achieved.


Anterior Cervical Reconstruction Using Free Vascularized Fibular Graft after Cervical Corpectomy.

Addosooki AI, Alam-Eldin M, Abdel-Wanis Mel-S, Yousef MA, Dionigi P, Kenawey MO - Global Spine J (2015)

Intraoperative view of the corpectomy defect with the black arrow pointing to the site of division of the posterior longitudinal ligament.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4836930&req=5

FI1500032-1: Intraoperative view of the corpectomy defect with the black arrow pointing to the site of division of the posterior longitudinal ligament.
Mentions: Two surgical teams operated simultaneously. We used the Smith-Robinson anterior cervical approach for corpectomy (Fig. 1) and a lateral approach to harvest the fibular graft.11 The skin was incised vertically to facilitate the dissection of the recipient vessels and graft placement. After incising the skin and platysma muscle, the dissection was continued carefully to prepare a superficial recipient vein (branch of the external jugular veins). Superficial veins are better than deep venae comitantes because they have larger diameters, thicker walls, and better drainage. Furthermore, anastomosis is much easier because it is carried superficially in a wide field. The pretracheal fascia was sharply incised medially to the carotid sheath. Based on the levels affected, either the superior thyroid artery or lingual artery was dissected gently and prepared as a recipient vessel. The prepared recipient vessel was well protected throughout the remainder of the procedure. We performed diskectomy followed by corpectomy at the desired levels until removal of the posterior longitudinal ligament, exposure of the dura, and complete decompression of the spinal cord were achieved.

Bottom Line: Results All patients achieved successful fusion.All patients achieved satisfactory clinical outcome.No neurologic injuries occurred during the operations.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Sohag University Hospital, Sohag, Egypt.

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.

No MeSH data available.


Related in: MedlinePlus