{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:03:43Z","timestamp":1786125823583,"version":"build-2736575974"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2021,2,20]],"date-time":"2021-02-20T00:00:00Z","timestamp":1613779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Pseudoarthrosis, or failure to achieve bony union, is a well-known complication of spinal fusion operations. Rates range from 5% to 40% and are influenced by both patient and technical factors. Patients who do not achieve complete fusion may experience a return or worsening of their preoperative pain. For patients with complicated pathologies, vascularized bone grafts (VBGs) have been shown to provide better outcomes than nonvascularized bone grafts (N-VBGs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To enhance an instrumented spinal fusion by the innovative technique presented herein that utilizes a rotated, pedicled VBG from the left eighth rib under the paraspinous musculature into the midlumbar posterolateral gutter.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>For posterior approaches, the rib can be easily accessed and rotated into the appropriate strut position. The rib is dissected out, identifying and preserving the neurovascular bundle medially. The rib is then tunneled medially and appropriately positioned as the spinal graft, with the curve providing anatomic kyphosis or lordosis, depending on the surgical location. It is then successfully fixated with plates and spinal screws.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>In our limited experience to date, vascularized rib grafting procedures augment fusion and reduce operating room time and bleeding compared to free flap procedures. No patients have experienced complications related to these grafts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Pedicled vascularized rib grafts can be utilized to provide the advantages of a vascularized bone flap in complicated pathologies requiring spinal fusion as far as the L2-L3 level, without the morbidity associated with free tissue transfer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opab035","type":"journal-article","created":{"date-parts":[[2021,2,21]],"date-time":"2021-02-21T00:14:40Z","timestamp":1613866480000},"page":"497-501","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":15,"title":["Vascularized Bone Grafts for Spinal Fusion\u2014Part 2: The Rib"],"prefix":"10.1227","volume":"20","author":[{"given":"Edward M","family":"Reece","sequence":"first","affiliation":[{"name":"Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA"},{"name":"Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikhil","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn M","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3233-8554","authenticated-orcid":false,"given":"Matthew J","family":"Davis","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA"},{"name":"Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9660-0697","authenticated-orcid":false,"given":"Amjed","family":"Abu-Ghname","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA"},{"name":"Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohil","family":"Shekher","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R","family":"Raber","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Winocour","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA"},{"name":"Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A","family":"Bohl","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander E","family":"Ropper","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,5]]},"reference":[{"issue":"3","key":"bib1-20251027","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1097\/BSD.0b013e3181e666d0","article-title":"The results of vascularized-free fibular grafts in complex spinal reconstruction","volume":"24","author":"Ackerman","year":"2011","journal-title":"J Spinal Disord Tech"},{"issue":"7","key":"bib2-20251027","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1097\/00007632-198907000-00014","article-title":"Temporal analysis of vascularized and nonvascularized rib grafts in canine spine surgery","volume":"14","author":"Shaffer","year":"1989","journal-title":"Spine (Phila Pa 1976)"},{"issue":"10","key":"bib3-20251027","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1097\/00007632-198810000-00017","article-title":"The superiority of vascularized compared to nonvascularized rib grafts in spine surgery shown by biological and physical methods","volume":"13","author":"Shaffer","year":"1988","journal-title":"Spine (Phila Pa 1976)"},{"issue":"6","key":"bib4-20251027","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.3171\/foc.2003.14.6.11","article-title":"General principles in the medical and surgical management of spinal infections: a multidisciplinary approach","volume":"17","author":"Quinones-Hinojosa","year":"2004","journal-title":"Neurosurg Focus"},{"issue":"1","key":"bib5-20251027","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.ocl.2006.10.011","article-title":"The role of vascularized bone grafts in spine surgery","volume":"38","author":"Shin","year":"2007","journal-title":"Orthop Clin North Am"},{"issue":"6","key":"bib6-20251027","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1097\/00000637-199312000-00010","article-title":"Vascularized bone flaps for thoracolumbar spinal fusion","volume":"31","author":"Yelizarov","year":"1993","journal-title":"Ann Plast Surg"},{"issue":"2","key":"bib7-20251027","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1001\/archsurg.1952.01260020343016","article-title":"Muscle pedicle bone grafts; 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