Delayed Fracture of Fibular Strut Allograft Following Multilevel Anterior Cervical Spine Corpectomy and Fusion

In Brief Study Design. Case report. Objective. To report the occurrence of the rare complication of fibular strut graft fractures in 2 patients. Summary of Background Data. Fatigue fracture of fibular strut allograft following anterior cervical corpectomy and fusion has rarely been reported. Methods. Two patients sustained delayed fractures of their anterior fibular strut allografts following combined three-level cervical corpectomy and posterior instrumented fusion at 9 and 17 months after surgery. Both patients had successfully fused both ends of their anterior strut grafts. Results. Both patients were successfully treated by revision posterior instrumented fusion without revision of the anterior strut. These patients’ allografts were harvested from the same donor, a 69-year-old woman. The tissue bank involved does not use donor age or osteoporosis as exclusion criteria for structural allograft donation. Conclusions. The fact that this relatively rare complication occurred in 2 patients who shared the same donor suggests that the mechanical strength of the donor allograft may have played a significant role in both fractures. Two patients had delayed fatigue fracture of their anterior fibular strut grafts following healing at both ends of the grafts. The shared 69-year-old female donor for these patients’ allografts and the rarity of this complication suggest that the strut grafts may have been structurally defective and that screening of allograft bone donors should perhaps include for risk factors associated with osteoporosis.