(324) Multi-Institutional Experience of Cervical Spine Reconstruction Using Fibula Free Flap

Monday, October 2, 2023

2:45 PM – 3:45 PM East Coast USA Time

Presenting Author(s)

Sara Yang, MD

Associate Professor
Oregon Health Science University
Portland, Oregon, United States

Co-Author(s)

RJ

Ryan S. Jackson, MD

Associate Professor
Washington University School of Medicine
St. Louis, MO, United States
CZ

Chad A. Zender, MD, FACS

Professor, Director Head and Neck Surgery
Department of Otolaryngology- Head and Neck Surgery, University of Cincinnati
Cincinnati, Ohio, United States
SK

Samir S. Khariwala, MD

Department of Otolaryngology, University of Minnesota, USA
AB

Arnuad Bewley, MD

UC Davis Health, USA
EM

Eric J. Moore, MD

Professor and Chair
Mayo Clinic
Rochester, Minnesota, USA

Senior Author(s)

MW

Mark K. Wax, MD, FACS, FRCS

Doctor
OHSU
Portland, OR, USA

Disclosure(s):

Sara Yang, MD: No relevant relationships to disclose.

Chad A. Zender, MD, FACS: No relevant relationships to disclose.

Mark K. Wax, MD, FACS, FRCS: No relevant relationships to disclose.

Introduction: Cervical spine defects result in spinal instability, putting the spinal cord and vertebral arteries at risk of damage and potentially leading to devastating neurological injuries. The fibula free flap can be utilized to span the cervical spine defect for stability. This method of reconstruction has been minimally discussed in the literature.

Methods: Multi-institutional retrospective case series reviewing patients who underwent cervical spine reconstruction with a fibula free flap. Patient demographic information, co-morbidities, levels of cervical spine defects, and free flap complications were collected.

Results: A total of 1187 fibula free flaps across 8 different institutions were reviewed. Twelve patients underwent cervical spine reconstruction with a fibula free flap. Average age was 51 + 22.3 years old with an age range of 12 to 79 years old. There were 5 males (41.7%) and 7 females (58.3%). The most common defect etiology was infection (n=6, 50%) followed by oncologic (n=3), trauma (n=1), and other (n=2). Three patients had a history of radiation therapy to the cervical region, resulting in cervical spine infection and subsequent defect. Most common level of cervical spine defect was C5 (n=9) followed by C6 (n=8) and C4 (n=7). Average number of segments reconstructed was 4. Six patients required both anterior and posterior cervical fusion. Four patients with reported neurologic deficits prior to surgery had an unchanged exam while 2 patients had improvement. One patient developed a fistula and wound infection and two had exposed hardware, but none of the patients had non-union.

Conclusions: Fibula free flap reconstruction for cervical spine defects has been rarely described in the literature. This case series demonstrates that a vascularized fibula bone graft is an excellent reconstructive option for cervical spine defects.