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Vascularized Fibular Strut Autografts in Spinal Reconstruction after Resection of Vertebral Chordoma or Chondrosarcoma: A Retrospective Series.
Neurosurgery. 2017 Jul 01; 81(1):156-164.N

Abstract

BACKGROUND

Margin-free en bloc resection is the best medical practice for primary vertebral chordoma and chondrosarcoma. Spinal reconstruction following total spondylectomy requires reconstructive interbody graft (allograft, devascularized autograft, vascularized autograft, or cage constructs) and instrumentation. An important consideration when choosing grafts and instrumentation is the durability and the long-term success of the fusion without subsidence.

OBJECTIVE

To evaluate the potential use of vascularized fibular autograft as a reconstructive strategy after en bloc resection.

METHODS

We present a series of 16 patients who underwent spondylectomy for primary vertebral chordoma or chondrosarcoma with reconstruction using a vascularized fibular autograft and anterior/posterior instrumentation between January 2011 and April 2014. We report postoperative neurological outcome, 6-mo rates of fusion and graft subsidence, and other complications.

RESULTS

Two patients passed away prior to 6-mo follow-up, and 1 patient was lost to follow-up. The mean follow-up time for the remaining 13 patients was 32 mo. Of these patients, 9 (69%) had evidence of fusion on the 6-mo follow-up computed tomography (CT) scan. Of the 4 patients who did not fuse, 2 had undergone surgery for new tumor diagnoses, 1 for hardware failure, and 1 for graft nonunion. Two patients (15%) had eventual graft subsidence along with hardware failure.

CONCLUSIONS

Vascularized fibular strut grafts are a viable method for reconstruction following spondylectomy. We present the largest series of patients to date utilizing this technique. Further comparative studies examining vascularized grafts vs nonvascularized grafts or metallic cage constructs will be important in choosing the best reconstructive strategy.

Authors+Show Affiliations

Departments of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts.Departments of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts.Departments of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts.Departments of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts.Departments of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts.Departments of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts.Departments of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28327915

Citation

Yanamadala, Vijay, et al. "Vascularized Fibular Strut Autografts in Spinal Reconstruction After Resection of Vertebral Chordoma or Chondrosarcoma: a Retrospective Series." Neurosurgery, vol. 81, no. 1, 2017, pp. 156-164.
Yanamadala V, Rozman PA, Kumar JI, et al. Vascularized Fibular Strut Autografts in Spinal Reconstruction after Resection of Vertebral Chordoma or Chondrosarcoma: A Retrospective Series. Neurosurgery. 2017;81(1):156-164.
Yanamadala, V., Rozman, P. A., Kumar, J. I., Schwab, J. H., Lee, S. G., Hornicek, F. J., & Curry, W. T. (2017). Vascularized Fibular Strut Autografts in Spinal Reconstruction after Resection of Vertebral Chordoma or Chondrosarcoma: A Retrospective Series. Neurosurgery, 81(1), 156-164. https://doi.org/10.1093/neuros/nyw057
Yanamadala V, et al. Vascularized Fibular Strut Autografts in Spinal Reconstruction After Resection of Vertebral Chordoma or Chondrosarcoma: a Retrospective Series. Neurosurgery. 2017 Jul 1;81(1):156-164. PubMed PMID: 28327915.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vascularized Fibular Strut Autografts in Spinal Reconstruction after Resection of Vertebral Chordoma or Chondrosarcoma: A Retrospective Series. AU - Yanamadala,Vijay, AU - Rozman,Peter A, AU - Kumar,Jay I, AU - Schwab,Joseph H, AU - Lee,Sang-Gil, AU - Hornicek,Francis J, AU - Curry,William T,Jr PY - 2015/10/19/received PY - 2016/11/15/accepted PY - 2017/3/23/pubmed PY - 2018/4/26/medline PY - 2017/3/23/entrez KW - Chondrosarcoma KW - Chordoma KW - En bloc resection KW - Spine tumor KW - Vascularized fibular strut graft SP - 156 EP - 164 JF - Neurosurgery JO - Neurosurgery VL - 81 IS - 1 N2 - BACKGROUND: Margin-free en bloc resection is the best medical practice for primary vertebral chordoma and chondrosarcoma. Spinal reconstruction following total spondylectomy requires reconstructive interbody graft (allograft, devascularized autograft, vascularized autograft, or cage constructs) and instrumentation. An important consideration when choosing grafts and instrumentation is the durability and the long-term success of the fusion without subsidence. OBJECTIVE: To evaluate the potential use of vascularized fibular autograft as a reconstructive strategy after en bloc resection. METHODS: We present a series of 16 patients who underwent spondylectomy for primary vertebral chordoma or chondrosarcoma with reconstruction using a vascularized fibular autograft and anterior/posterior instrumentation between January 2011 and April 2014. We report postoperative neurological outcome, 6-mo rates of fusion and graft subsidence, and other complications. RESULTS: Two patients passed away prior to 6-mo follow-up, and 1 patient was lost to follow-up. The mean follow-up time for the remaining 13 patients was 32 mo. Of these patients, 9 (69%) had evidence of fusion on the 6-mo follow-up computed tomography (CT) scan. Of the 4 patients who did not fuse, 2 had undergone surgery for new tumor diagnoses, 1 for hardware failure, and 1 for graft nonunion. Two patients (15%) had eventual graft subsidence along with hardware failure. CONCLUSIONS: Vascularized fibular strut grafts are a viable method for reconstruction following spondylectomy. We present the largest series of patients to date utilizing this technique. Further comparative studies examining vascularized grafts vs nonvascularized grafts or metallic cage constructs will be important in choosing the best reconstructive strategy. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/28327915/Vascularized_Fibular_Strut_Autografts_in_Spinal_Reconstruction_after_Resection_of_Vertebral_Chordoma_or_Chondrosarcoma:_A_Retrospective_Series_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1093/neuros/nyw057 DB - PRIME DP - Unbound Medicine ER -