Cervical Spine and Craniocervical Junction Reconstruction with a Vascularized Fibula Free Flap

Abstract

Background: Long-term stabilization of the cervical spine after extensive multilevel tumor resection is difficult to achieve. The current standard approach of instrumentation combined with allograft or nonvascularized autograft is limited in settings of increased risk of nonunion or delayed union (i.e., prior radiation therapy or poorly vascularized wound beds).

Case description: We report the first time to our knowledge that a vascularized fibular free flap has been used to reconstruct the cervical column across 5 vertebral levels, from the craniocervical junction to the lower cervical spine. We describe a transoral approach to the area and compare this method with other reconstructive options.

Conclusions: Vascularized bone grafting is a viable alternative to achieve lasting stability because of hastened fusion time, limited reliance on osseous remodeling, and incorporation into the axial skeleton with strut strength.

Keywords: Cervical reconstruction; Epithelioma; Free vascularized fibular grafts; Spinal reconstruction; Vascularized bone grafts.