Reconstruction of posterior elements of the spine with femoral shaft allograft after spondylectomy for En bloc resection of tumor.

PURPOSE

En bloc spondylectomy for spine tumors involves extensive removal of posterior vertebral elements, which are difficult to reconstruct. Often, the dura is left exposed, leading to scarring and adhesions which complicate revision surgeries. Synthetic barriers can be used to reduce adhesions, but they offer no structural support. Here, we present a novel technique using cadaveric femoral struts for posterior column reconstruction, creating a lamina-like structure spanning across the defect.

METHODS

We conducted a retrospective institutional review of patients who underwent en bloc spondylectomy followed by reconstruction of the posterior elements using frozen cadaveric femoral struts. Allografts were contoured to fit adjacent spinous processes and secured with posterior instrumentation, creating a mechanical barrier with potential for osseous integration.

RESULTS

Nineteen patients (mean age: 52 years; 7 female) underwent the procedure for 14 primary and 5 metastatic tumors. Eight complications occurred, none related to the allograft. The construct aided in surgical re-exposure and protected the thecal sac during wound revisions. Of six patients with long-term follow-up CT scans, three showed allograft integration with solid fusion. Median follow-up was 27.6 months.

CONCLUSIONS

Femoral allografts offer a simple, low-risk method for reconstruction of the posterior elements following spondylectomies, providing structural support and facilitating revision surgeries. Additional long-term data are needed to confirm their efficacy.