• Stephen J Lewis, Arvind G Kulkarni, Yoga Raja Rampersaud, Subir Jhaveri, Nasir Quraishi, Sarah A Bacon, and Sofia P Magana.
• Division of Orthopaedics, Toronto Western Hospital, 399 Bathurst St., Toronto, Ontario, Canada. Stephen.Lewis@uhn.on.ca
• Spine. 2012 Feb 15; 37 (4): 346350346-50.

Study DesignRetrospective review of consecutive case series.ObjectiveTo evaluate the efficacy of using autologous rib graft for fusion across long posterior column defects.Summary Of Background DataAchieving fusion across large posterior column defects after en bloc tumor resection can be difficult. Rib graft can be harvested from the local wound, and its shape and structural properties are well suited for reconstruction of thoracic posterior column deficits.MethodsAfter Research Ethics Board approval, a retrospective review of the charts of 17 consecutive patients undergoing posterior column reconstruction after en bloc tumor resections was carried out. Autologous vascularized and nonvascularized rib grafts were utilized in 8 and 9 cases, respectively; 14 patients with malignant tumors and 3 with benign etiology. After surgery, patients underwent routine clinical and radiographic follow-up, with a computed tomographic scan performed at a minimum of 6 months in all surviving patients. Clinical and radiographic films were analyzed.ResultsComputed tomographic scans at a minimum of 6 months demonstrated graft incorporation in all surviving cases. There was no obvious difference at 6-month imaging to differentiate vascularized from nonvascularized grafts. There were no cases of graft dislodgement or fracture. Graft site morbidity was difficult to isolate from the morbidity of these large procedures. No complications related to the graft were identified.ConclusionThe use of autologous rib graft with a proximal step-cut and distal saddle-cut supplemented with posterior instrumentation allowed immediate stabilization of the posterior column defect created by the en bloc tumor resection. This technique of fashioning the graft and taking advantage of its natural curved structure for immediate press-fit was associated with graft incorporation in our cases.

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