Abstract
The use of free vascularized fibula grafts (FVFG) in complex spinal deformity surgery intends to allow for life-long stability of the spine with good long-term clinical outcome. However, these long-term outcomes of this technique are still lacking. The objective of this study is to report the long-term postoperative outcomes and establish the long-term viability of this method for spinal reconstruction. A retrospective cohort study was conducted in all patients who underwent spinal reconstructive surgery utilizing a FVFG at a tertiary medical centre. Questionnaires taken from the participants were the Numeric Pain Rating Scale (NPRS), Oswestry Low Back Pain Disability (also known as Oswestry Disability Index (ODI)), Scoliosis Research Society 22r (SRS-22), the EQ-5D-5L and a self-assembled questionnaire regarding donor site comorbidities and patient satisfaction. Over a period of 24 years (1995-2019), we used FVFG for spinal reconstruction in 31 patients. A total of 25 patients were included in this study, 8 patients were deceased at the time of this study, and sixteen patients responded to the questionnaires. Patient satisfaction was rated 6.8 out of 10, the average SRS-22r score was 3.6, EQ-5D-5L score was 0.725, and the ODI score showed a minimal disability (0-20%) postoperatively. Overall complication-free survival was 8.9 years. Nine patients underwent a re-operation in the spinal area; five for the removal of the spinal instrumentation. Patients reported satisfied and good long-term outcomes following FVFG surgical procedure for complex spinal deformities. Therefore, considering the alternatives, this procedure provides a good long-term solution for complex spinal deformity surgery.
Highlights
Severe spinal deformity, pseudarthrosis, infection and oncological resections can cause spinal instability leading to functional and neurological impairment
Posterior and/or anterior spinal instrumentation combined with cages or bone grafts is the most common approach to this problem
Patients with a reasonable life expectancy are mostly treated with bone grafts
Summary
Pseudarthrosis, infection and oncological resections can cause spinal instability leading to functional and neurological impairment. It is essential to create long-lasting spinal stability. Posterior and/or anterior spinal instrumentation combined with cages or bone grafts is the most common approach to this problem. All mechanical devices will progressively lose mechanical stability and will eventually result in collapse.[1] The only way long lasting stability can be achieved is by bony consolidation. For this reason, patients with a reasonable life expectancy are mostly treated with bone grafts
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