PubMed · 10510664
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D Josefson. 1999. Surgeons develop composite bone transplants.. https://pubmed.ncbi.nlm.nih.gov/10510664/
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STUDY DESIGN: One case is reported in which a failed anterior fusion for Grade 4 spondylolisthesis was treated with a vascularized fibular strut graft using a posterior approach. OBJECTIVES: To demonstrate the applicability of this technique for salvage cases or patients with systemic conditions that may decrease the success of more standard techniques. SUMMARY OF BACKGROUND DATA: Surgical stabilization of spondylolisthesis through posterior approach with a fibular strut graft has been previously described. A vascularized strut graft can be used in the treatment of spondylolisthesis and may have applicability in those patients with underlying disease that may impair the use of more standard techniques or in salvage reconstruction. METHODS: With the patient under general anesthesia, through a posterior approach S1 and L4 were decompressed. The fibula with its vascularity intact was harvested and anastomosed with the superior gluteal artery and vein. The fibular strut was placed into the space formed by reaming between L5 and S1. Ilial autograft was used to augment the posterior fusion. After the procedure the patient was placed in a hip spica cast. RESULTS: At the 2-year follow-up the patient has incorporation of the graft, with no evidence of fracture and no significant progression of anterior slip. CONCLUSION: A vascularized fibular strut graft is a feasible alternative in the treatment of severe spondylolisthesis. No complications were encountered in the involved patient. Future application may include salvage reconstruction of failed arthrodesis or in individuals with systemic conditions that may impair graft incorporation using more standard techniques.
Different methods are recommended for the surgical reconstruction of the resected mandible. The advantages for implant stabilised prostheses in restoring the occlusion are recognised but few papers provide adequate data to identify the successful outcome of treatment. The literature is reviewed and the advantages of imaging together with the use of digitised data is highlighted by a case requiring rehabilitation with enhanced planning methods.
STUDY DESIGN: The case report of a 60-year-old man with late onset back pain after lumbar spine fusion is presented. OBJECTIVE: To report the rare complication of bilateral pedicle stress fractures after instrumented posterolateral lumbar fusion. SUMMARY OF BACKGROUND DATA: A 56-year-old man underwent revision spinal surgery for ongoing back pain secondary to pseudoarthroses. A posterolateral L4-S1 instrumented fusion using pedicle screws was performed. Autologous bone graft was applied to the decorticated lateral masses. The internal fixation was removed 2 years later, at which time plain radiographs showed that the fusion mass was solid. At the age of 60 years, the man presented with worsening back pain. Plain radiographs and computed tomographic scans demonstrated bilateral L4 pedicle stress fractures. A bone scan indicated that these were recent in origin. METHOD: The clinical assessment was undertaken by the senior author and surgeon. Investigations included plain radiography, computer tomography, and scintographic imaging. A systematic literature review of the relevant publications was performed. RESULTS: In the reported patient, bilateral pedicle stress fractures developed 2 years after pedicle screw removal from an L4-S1 instrumented posterolateral lumbar spine fusion. This occurred at the uppermost level of the fusion mass. CONCLUSIONS: The pedicle is the weakest point in the neural arch after posterolateral fusion. Although movement continues at the level of the disc space anteriorly, the pedicle is susceptible to fracture. Pedicle fracture is a rare late complication of posterolateral lumbar spine fusion.