Free vascularized bone graft in spinal surgery: indications and outcome in eight cases.
(17/1358)
In selected spinal deformities the use of a vascularized graft to establish fusion may be considered: compared to a non-vascularized graft it has superior mechanical properties, resulting in greater graft strength and stiffness, and greater effectiveness in facilitating union. Eight patients with a progressive spinal deformity (four cases) and malignancy (four cases) were treated with resection and/or correction and stabilization. To facilitate (multi)level fusion vascularized fibular grafts were used in two cervical and two thoracolumbar deformities. Fibular (two cases) or iliac grafts (two cases) were used in four cases of spinal reconstruction after vertebrectomy for malignancy. In all patients complete incorporation of the graft was obtained within 5 weeks to 8 months postoperatively. Complications occurred in three cases: one patient had a transient laryngeal edema and laryngeal nerve palsy. Another patient had a non-fatal deep vein thrombosis with pulmonary embolisms, successfully treated with anticoagulants. A third patient developed a lung infection and subsequently a deep infection around the dorsal instrumentation; after hardware removal the infection was controlled. At the latest follow-up (mean 30 months, range 24-48 months) six out of eight patients are alive. One patient died 2.5 years after the intervention due to widespread metastases, while another patient died in the postoperative period due to unknown reasons. Vascularized bone graft in spinal surgery facilitates primary mechanical stability and rapid fusion, and it has higher resistance to infection. The variety of applications of a vascularized graft may extend the range of indications for the use of grafts in spinal surgery. (+info)
The use of titanium surgical mesh-bone graft composite in the anterior thoracic or lumbar spine after complete or partial corpectomy.
(18/1358)
Various conditions such as fracture, dislocation, tumor, or infection adversely affect the vertebral body and lead to instability. Restoration of a stable anterior column is essential for normal spinal biomechanics. Various biological and mechanical spacers have been used to reconstruct the anterior column after corpectomy. In this retrospective review, the authors evaluated clinical charts and radiographs of 13 patients receiving titanium surgical mesh (TSM)-bone graft composite to reconstruct the anterior spinal column in the thoracic or lumbar region. The objective of this review was to evaluate the stability and efficacy of the TSM-bone graft composite in the anterior spine after a complete or partial corpectomy. Sixteen patients with involvement of the thoracic or lumbar vertebral column after trauma, tumor, or infection underwent partial or complete corpectomy. In all patients the anterior defect was reconstructed using a TSM-bone graft composite. Three patients died within 12 months postoperatively due to primary malignant process. Thirteen of 16 patient charts and radiographs were evaluated for anterior fusion status, settling of the TSM-bone graft composite, and hardware failure. No pseudoarthroses were noted. Evidence of solid anterior fusion was noted in all patients. The average settling of the TSM-bone graft construct was 3 mm. All patients presenting with only pain and no neurological symptoms (n = 9) experienced early pain relief. For patients presenting with neurological symptoms (n = 4), the recovery was complete in three and partial in one. No patient was made neurologically worse, and there were no vascular injuries intra- or postoperatively. The study suggests that TSM-bone graft composite offers excellent biomechanical stability in the immediate postoperative period, permitting progressive maturation of the fusion mass. (+info)
Femoral head necrosis treated with vascularized iliac crest graft.
(19/1358)
We reviewed 24 hips with avascular necrosis of the femoral head in 24 patients treated with vascularized iliac bone grafts 12 years after operation. In 7 patients the necrosis was classified as Ficat Stage II and in 17 patients as Stage III. Eight patients showed poor results. In 6 hips with fair results, moderate progression of the necrosis was noted at 3 to 8 years postoperatively. In 5 hips showing good results, slow progression with incipient signs of arthrosis were noted 8 years after surgery. In the remaining 5 patients with excellent results, no evidence of progression was noted 9 to 14 years postoperatively. The method described is recommended for treatment in the Ficat Stage II and early Stage III, when necrosis does not yet involve the complete femoral head. (+info)
Xenogenic demineralized bone matrix: osteoinduction and influence of associated skeletal defects in heterotopic bone formation in rats.
(20/1358)
Demineralized bone matrix (DBM) was ectopically implanted in 36 male Wistar rats. In 18 of the animals a bone defect in the femoral condyles was also created: the left was filled with DBM and the right was left empty as a control. The animals were killed after 2, 4 and 6 weeks and new bone was histologically evaluated, comparing ectopic bone formation with or without distant bone injury. Results showed: (1) osteoinductivity of xenogenic DBM, and (2) earlier mineralization of ectopically implanted DBM in the group with associated skeletal injury. Our results show that xenogenic bone matrix acts as an osteoinductive material and that skeletal injury improves osteogenesis at distant sites. (+info)
A 5-year post-operative review of secondary alveolar bone grafting in the Yorkshire region.
(21/1358)
The objective of this study was to determine the quality of secondary alveolar bone grafting in the Yorkshire region, and consisted of a retrospective review of patients case notes and radiographs at five surgical units within the Yorkshire region. The subjects were 109 patients who had secondary alveolar bone grafting between 1.9.91. and 31.8.96. The quality of outcome was assessed using a four-point radiographic scale from occlusal radiographs taken at least 3 months post-operatively: Grade 1 = > 75 per cent bony in-fill, Grade 2 = 50-75 per cent bony in-fill, Grade 3 = < 50 per cent bony in-fill, and Grade 4 = no bony bridge. The radiographic assessment scale was assessed for reliability: inter-examiner weighted kappa = 0.622-0.715 and intra-examiner = 0.818-0.943. Grade 1 results were achieved in 63.2 per cent patients receiving orthodontic expansion and in 40 per cent without expansion before grafting. The four-point radiographic scale described is a useful tool in assessing alveolar bone grafting, Orthodontic expansion. (+info)
Loads on internal spinal fixators measured in different body positions.
(22/1358)
Telemeterized internal spinal fixation devices were implanted in ten patients. The loads acting on the fixators were compared for different body positions, including standing, sitting, and lying in a supine, prone, and lateral position. Implant loads differed considerably from patient to patient depending, for example, on the indication for surgery and the surgical procedure. They were altered by anterior interbody fusion. Mostly, only small differences in implant loads were found for the various lying positions. Flexion bending moments were significantly higher in upright than in lying body positions. Loads on the fixators were not higher for sitting than for standing. Patients who have undergone mono- or bisegmental spine stabilization should therefore be allowed to sit as soon as they can leave the bed. (+info)
Bone-patellar tendon-bone reconstruction of the anterior cruciate ligament. A long-term comparison of early and late repair.
(23/1358)
Ninety-one patients were assessed 5-9 years after an anterior cruciate ligament reconstruction (bone patella-tendon bone autograft). Forty-eight patients had been treated within 6 weeks of the injury (Group I) and 43 patients more than 3 months after the injury (Group II). 73 patients had either a normal or nearly normal final outcome. The mean Lysholm score was 82 and the mean Marshall score was 42. Eighty nine patients had normal or nearly normal stability in the operated knee when compared to the contralateral joint. In none of these results was there any significant difference between the groups. Results of functional and of isokinetic strength tests, as well as the presence of anterior knee pain, were also similar in both groups. However, patients with early reconstruction had fewer degenerative changes in the tibio-femoral joint and were more satisfied with the result. They also returned to their pre-injury level of sports activity more often than those patients in the late reconstruction group. (+info)
Ipsilateral vascularised fibular transport for massive defects of the tibia.
(24/1358)
The ipsilateral and contralateral fibulae have been used as a vascularised bone graft for loss of tibial bone usually by methods which have involved specialised microvascular techniques to preserve or re-establish the blood supply. We have developed a method of tibialisation of the fibula using the Ilizarov fixator system, ipsilateral vascularised fibular transport (IVFT), and have used it in five patients with massive loss of tibial bone after treatment of an open fracture, infected nonunion or chronic osteomyelitis. All had successful transport, proximal and distal union, and hypertrophy of the graft without fracture. One developed a squamous-cell carcinoma which ultimately required amputation of the limb. The advantage of IVFT is that the fibular segment retains its vascularity without the need for microvascular dissection or anastomoses. Superiosteal formation of new bone occurs if the tibial periosteal bed is retained. Other procedures such as corticotomy and lengthening can be carried out concurrently. (+info)