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Anterior thoracic spine reconstruction using a titanium mesh cage and pedicled rib flap. | LitMetric
Study Design : A retrospective clinical study.Objectives : To evaluate the safety and efficacy of using an integrated titanium mesh cage and pedicled rib flap for thoracic spine reconstruction in patients at high risk of pseudarthrosis.Summary Of Background Data : A variety of materials are available for interbody thoracic reconstruction; however, the optimal treatment of patients at high risk of pseudarthrosis remains a challenging problem. Free or pedicled bone flaps have been shown to be highly effective in terms of promoting fusion and titanium mesh cages provide excellent structural support.Methods : Eleven patients who underwent anterior thoracic corpectomy and spinal reconstruction using an integrated titanium mesh cage and pedicled rib flap were analyzed with a mean follow-up of 37 months (range, 25-55 months). The etiology of spinal disease was infection in 7 (64%) patients and tumor in the remaining 4 (36%) patients. Seven (64%) patients were treated with only an anterior approach while the remaining 4 (36%) patients underwent circumferential spinal reconstruction.Results : All patients demonstrated clinical and radiographic evidence of spinal fusion at the time of follow-up. All patients had stable or improved Frankel grades after surgery. There was a mean kyphosis correction of 7 degrees for both the focal and regional thoracic kyphosis. There were three significant postoperative complications: bilateral pleural effusion, gram-negative bacteremia, and transient right lower extremity weakness requiring reoperation and pedicle screw revision. Two patients died after surgery: one from aneurysmal subarachnoid hemorrhage and the other from complications of breast cancer.Conclusions : The use of an integrated rib flap and titanium mesh cage construct appears to be a safe and effective means of providing immediate and substantial anterior column support as well as achieving arthrodesis in challenging fusion candidates.
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