Late stress fracture of a well-incorporated autologous fibula strut graft in the cervical spine: a case report.

Four-level corpectomy for cervical spondylotic myelopathy presents special challenges to successful outcomes. At our institution, where the senior author has performed over 300 multilevel corpectomies with autologous fibula reconstruction, only 11 four-level procedures have been performed. It is important to consider the length of time required for complete revascularization of these long strut grafts as well as unusual postural or gait biomechanics the patient may have. Patients with altered gait or trunk stability who require anterior surgery for cervical spondylotic myelopathy may be best served by concurrent posterior fusion. We report a case in which a patient with cervical spondylotic myelopathy and diplegic cerebral palsy developed a stress fracture in the midportion of his well-incorporated autologous fibula strut graft 1 year after it was placed following four-level corpectomy.