Rib-Strut Graft for Pediatric Spinal Deformity: A Comparison Between Vascularized and Non-Vascularized Rib Graft

Methods: An IRB-approved retrospective review of all patients at a single institution who had a rib-strut graft placed for pediatric spinal deformity was performed. The medical record was reviewed for demographic data, date of surgery, complications, postoperative follow-up. The radiographs were reviewed preoperatively, postoperatively, and at minimum two-year follow-up. The two groups were compared statistically.

Results: There were 32 patients in the NVRG group and 20 patients in the VRG group. The average age of the patients in the NVRG group was younger (9.3 vs. 12.3 years). The body mass index (21.4 vs. 23.0cm/kg2), weight (35.1 vs. 42.1 kg), the number of anterior levels fused (4.9 vs. 5.1), and the levels in which the strut was placed (4.7 vs. 5.1) were similar between the NVRG group and the VRG groups. However, the NVRG group had less blood loss (362 vs 504 ccs), and the anterior surgical time was less (216 vs 282 minutes) (p=0.002). The radiographic assessment demonstrated no difference between the NVRG and VRG groups with respect to preoperative kyphosis (61.4º vs 71.2º), postoperative kyphosis (57.2º vs. 59.8º), 1 year (55.0º vs. 59.5º) and 2 year kyphosis (54.8º vs. 60.0º). There was no difference between the NVRG and the VRG groups in the time to union of the anterior strut graft (4.5 vs. 4.4 months) (p=0.83) or the incidence of complications.

Conclusions: The use of a vascularized rib strut graft does not seem to offer any distinct advantages when compared to a rib strut graft without a vascular pedicle in pediatric spinal deformity.