Reece Edward M, Davis Matthew J, Wagner Ryan D, Abu-Ghname Amjed, Cruz Alex, Kaung Geoffrey, Verla Terence, Winocour Sebastian, Ropper Alexander E
Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA.
Oper Neurosurg. 2021 Apr 15;20(5):493-496. doi: 10.1093/ons/opab037.
Iliac crest autograft has been the gold standard for harvest of fusion materials in spine surgery. The benefits of a vascularized version of this bone graft-including delivery of stem cells, ability to deliver antibiotics to the fusion bed, and relative ease of harvest-make this technique superior to free bone transfer in the achievement of augmented spinal fusion.
To present a brief summary of similar existing concepts before describing the novel technique of this vascularized posterior iliac crest bone graft.
Vascularized posterior iliac crest bone graft can be harvested from the same midline lumbar incision used for thoracolumbar spinal fusion, through lateral dissection around the paraspinals to the iliac crest. Recipient sites in the posterolateral bony spinal gutters may be as rostral as T12 and caudal as the sacrum. The ability to cover multiple lumbar levels can be achieved with desired lengths of the donor iliac crest.
Over 14 vascularized iliac crest bone grafts have been performed to augment lumbar fusion for salvage after pseudoarthrosis. Operative time and bleeding are reduced compared to free flap procedures, and no patients have experienced any complications related to these grafts. Indocyanine green (ICG) angiography has been utilized in a novel way to ensure the vascularity of the bone graft prior to arthrodesis.
While long-term follow-up will be required to fully characterize fusion rates and patient morbidity, this innovative surgical option augments spinal fusion in patients with, or at increased risk for, pseudoarthrosis.
在脊柱手术中，髂嵴自体骨移植一直是获取融合材料的金标准。这种带血管蒂骨移植的优点包括输送干细胞、向融合床输送抗生素的能力以及相对容易获取，使得该技术在实现增强型脊柱融合方面优于游离骨移植。
在描述这种带血管蒂的后髂嵴骨移植新技术之前，简要总结现有的类似概念。
带血管蒂的后髂嵴骨移植可通过用于胸腰椎脊柱融合的相同中线腰部切口获取，经椎旁肌外侧解剖至髂嵴。脊柱后外侧骨沟中的受区可上至T12，下至骶骨。使用所需长度的供体髂嵴可覆盖多个腰椎节段。
已进行了超过14例带血管蒂的髂嵴骨移植以增强腰椎融合，用于假关节形成后的挽救治疗。与游离皮瓣手术相比，手术时间和出血量减少，且没有患者出现与这些移植相关的任何并发症。吲哚菁绿（ICG）血管造影已以一种新的方式用于在关节融合术前确保骨移植的血管供应。
虽然需要长期随访以全面评估融合率和患者发病率，但这种创新的手术选择可增强假关节形成患者或假关节形成风险增加患者的脊柱融合。
