68. The Use of Spino-plastic Surgery in Patients With Complex Spinal Reconstructive Needs: An Initial Cohort And Associated Outcomes

PURPOSE: Complex spinal surgeries are often performed in the setting of spinal deformity or degenerative disease, and are frequently impacted by complications including pseudoarthrosis, infection, and delayed wound healing. Plastic surgeons continue to play an evolving role in the context of spinal surgery, and recently the emerging field of Spino-plastic Surgery has sought to improve outcomes through the utilization of vascularized bone grafts (VBGs). VBGs are a form of pedicled tissue flaps whereby bony segments are transferred via muscular attachments without the inclusion of a named vessel, relying on perfusion from Sharpey’s fibers. Recently, our institution has implemented this technique in several patients undergoing complex surgery throughout all levels of the spine. The purpose of our study is to summarize this initial cohort and its associated outcomes, serving as the first study to document the results from a series of patients treated with Spino-plastic Surgery. METHODS: A retrospective chart review was conducted, selecting for spinal surgeries which utilized VBGs between October 2022 and July 2024. All surgeries were performed by a single neurosurgeon in collaboration with a single plastic surgeon within the same institution. Patient demographics and comorbidities were recorded. Primary outcome metrics included patient symptoms (e.g. pain, function) at most recent follow up, time to ambulation post-operatively, length of surgery, length of hospital stay, and readmission and reoperation rates. A cohort of similarly-complex control patients was selected for comparison between VBG and non-VBG patients. Data were summarized using descriptive statistics, and univariate analysis was performed. RESULTS: Upon review, 28 total VBGs were performed in 16 patients, of which 24 grafts were harvested from the iliac crest, two from the ribs, and two from the occipital bone. The cohort had a mean age of 63.8 ± 14.7 years, and 10 (63%) had a history of previous spinal surgery. All patients underwent at least one muscle transposition flap for spinal closure in addition to the VBG. Among the 16 patients who received VBGs, 13 (81%) reported substantial improvement with regards to pain, two (15%) reported stable symptoms, and one patient experienced worsening of symptoms at the most recent follow-up visit. First ambulation event occurred at a mean 3.1 days post-operatively, and average length of hospital stay was 6.4 days. A cohort of five control patients was also identified, and no statistically-significant differences were observed between VBG and non-VBG groups in terms of hospital stay (p=0.730), operative time (p=0.599), or estimated blood loss (p=0.956). CONCLUSION: The use of VBGs in spinal surgery is associated with improvements to pain and function, with over 80% of patients experiencing meaningful improvement at their most recent follow up. Furthermore, the use of VBGs does not lead to significantly increased operating room time, intraoperative blood loss, or hospitalization length when compared to a control cohort undergoing similar surgeries without the use of VBGs. As an emerging technique, VBGs appear to be a safe and effective method to augment complex spinal surgeries and promote high-quality outcomes, and future research will be essential in refining its surgical applications.