Experiences of Free Vascularized Fibular Grafts as Anterior Strut Grafts of the Spine

For the treatment of kyphoscoliosis of the spine associated with tuberculosis or neurofibromatosis, it must be required to get much stronger strut graft concomitantly with posterior instrumentation of the spine. Five cases (2 tuberculosis, 2 neurofibromatosis and 1 thoracolumbar OPLL) were treated by free vascularized fibular grafts as anterior strut grafts. An average length of the grafted fibula was 9.9cm (maximal length, 12.5cm). The nutrient arteries of the fibula were anastomosed with the thoracodorsal artery in one case and the lumbar arteries in 4 cases. Four out of 5 cases obtained good bony union and 3 cases showed increase in diameter of the grafted fibulae at an average follow-up period of 15.2 months. In conclusions, this free vascularized fibular grafting is a good procedure to get stability of the spine in combination with posterior instrumentation for the unstable spine associated with tuberculosis, neurofibromatosis, etc.