[Vertebral body replacement with a rib segment block in transthoracic intervention].

The aim of this clinical report is to describe the outcome of 7 patients regarding the efficiency of a vertebral body replacement with rib bone for destructive lesions in the thoracic spine. In these patients, an autologous bone block shaped from four rib segments, was used as a vertebral body replacement. In order to compose the bone block, the ribs were fused by means of one or two commercialized titanium screws. In a retrospective study the following parameters were analysed: neurological status, rate of bony fusion, primary correction gain, secondary correction loss. Mean time of follow-up was eleven months (range 6-20). Neurological improvement was found in 83.3% of patients treated with ventral decompression. Immediate postoperative gain of correction was 9.4 angle degrees, secondary loss of correction was 11.4 angle degrees, the latter resulting from the impression of the rib segments into the adjacent vertebrae. Radiological bony fusion of the rib implants could be observed in all cases. To avoid a secondary loss of correction, ventral fusion using an osteosynthesis plate and, in singular cases, the dorsal implantation of a fixateur interne is advantageous. An additional advantage of this new method is that autologous bone harvesting is accomplished during the surgical approach, rendering a separate approach for this purpose superfluous (thus shortening operation time, reducing morbidity and operative complications). We conclude from our results that the composed rib block is an attractive alternative vertebral body replacement which provides sufficient stability and osteogenic capacity.