Download PDF
Semin Plast Surg 2021; 35(01): 014-019
DOI: 10.1055/s-0041-1723834
Review Article

Vascularized Occipital Bone Grafting: Indications, Techniques, Clinical Outcomes, and Alternatives

Sebastian J. Winocour
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Erica Y. Xue
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
2   Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
,
Michael A. Bohl
3   Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
,
Farrokh Farrokhi
4   Department of Neurosurgery, Virginia Mason Hospital, Seattle, Washington
,
Matthew J. Davis
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
2   Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
,
Amjed Abu-Ghname
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
2   Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
,
Alexander E. Ropper
5   Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
,
Edward M. Reece
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
2   Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
5   Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Successful arthrodesis at the craniocervical junction and atlantoaxial joint can be more challenging than in other segments of the cervical spine. Different techniques for spinal fixation in this region have been well described, along with auxiliary methods to improve fusion rates. The occipital vascularized bone graft is a novel technique that can be used to augment bony arthrodesis in the supra-axial cervical spine. It provides the benefits of a vascularized autologous graft, such as accelerated healing, earlier fusion, and increased strength. This technique can be learned with relative ease and may be particularly helpful in cases with high risk of nonunion or pseudoarthrosis in the upper cervical spine.

Keywords

vascularized bone graft - spinoplastic reconstruction - occipital graft - autograft - spinal fusion


Publication History

Article published online:
10 May 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Lee DJ, Ahmadpour A, Ament JD, Goodarzi A, Panchal RR. When is occipitocervical fusion necessary for upper cervical injuries?. Semin Spine Surg 2017; 29: 20-26
    CrossrefPubMedGoogle Scholar
  • 2 Reece EM, Vedantam A, Lee S. et al. Pedicled, vascularized occipital bone graft to supplement atlantoaxial arthrodesis for the treatment of pseudoarthrosis. J Clin Neurosci 2020; 74: 205-209
    CrossrefPubMedGoogle Scholar
  • 3 Shroeder GD, Baaj AA, Vaccaro AR. Revision Spine Surgery: Pearls and Pitfalls. Boca Raton, FL: Taylor & Francis Group, LLC; 2020
    Google Scholar
  • 4 Newman P, Sweetnam R. Occipito-cervical fusion. An operative technique and its indications. J Bone Joint Surg Br 1969; 51 (03) 423-431
    CrossrefPubMedGoogle Scholar
  • 5 Bohl MA, Mooney MA, Catapano JS. et al. Pedicled vascularized bone grafts for posterior occipitocervical and cervicothoracic fusion: a cadaveric feasibility study. Oper Neurosurg (Hagerstown) 2018; 15 (03) 318-324
    CrossrefPubMedGoogle Scholar
  • 6 Winegar CD, Lawrence JP, Friel BC. et al. A systematic review of occipital cervical fusion: techniques and outcomes. J Neurosurg Spine 2010; 13 (01) 5-16
    CrossrefPubMedGoogle Scholar
  • 7 Jandali S, Diluna ML, Storm PB, Low DW. Use of the vascularized free fibula graft with an arteriovenous loop for fusion of cervical and thoracic spinal defects in previously irradiated pediatric patients. Plast Reconstr Surg 2011; 127 (05) 1932-1938
    CrossrefPubMedGoogle Scholar
  • 8 Shaffer JW, Davy DT, Field GA, Bensusan JS, Kellis GJ. The superiority of vascularized compared to nonvascularized rib grafts in spine surgery shown by biological and physical methods. Spine 1988; 13 (10) 1150-1154
    CrossrefPubMedGoogle Scholar
  • 9 Mladenov KV, Kunkel P, Stuecker R. The use of recombinant human BMP-2 as a salvage procedure in the pediatric spine: a report on 3 cases. Eur Spine J 2010; 19 (Suppl. 02) S135-S139
    CrossrefPubMedGoogle Scholar
  • 10 Lu DC, Sun PP. Bone morphogenetic protein for salvage fusion in an infant with Down syndrome and craniovertebral instability. Case report. J Neurosurg 2007; 106 (6, Suppl): 480-483
    PubMedGoogle Scholar
  • 11 Oluigbo CO, Solanki GA. Use of recombinant human bone morphogenetic protein-2 to enhance posterior cervical spine fusion at 2 years of age: technical note. Pediatr Neurosurg 2008; 44 (05) 393-396
    CrossrefPubMedGoogle Scholar
  • 12 Benglis D, Wang MY, Levi AD. A comprehensive review of the safety profile of bone morphogenetic protein in spine surgery. Neurosurgery 2008; 62 (05) (Suppl. 02) ONS423-ONS431 , discussion ONS431
    PubMedGoogle Scholar
  • 13 Yasmeh S, Quinn A, Harris L. et al. Periosteal turndown flap for posterior occipitocervical fusion: a technique review. Eur Spine J 2017; 26 (09) 2303-2307
    CrossrefPubMedGoogle Scholar
  • 14 Koop SE, Winter RB, Lonstein JE. The surgical treatment of instability of the upper part of the cervical spine in children and adolescents. J Bone Joint Surg Am 1984; 66 (03) 403-411
    CrossrefPubMedGoogle Scholar
  • 15 Bohl MA, Hlubek RJ, Turner JD, Kakarla UK, Preul MC, Reece EM. Far-lateral vascularized rib graft for cervical and lumbar spinal arthrodesis: cadaveric technique description. Plast Reconstr Surg Glob Open 2019; 7 (04) e2131
    CrossrefPubMedGoogle Scholar
  • 16 Rolle ML, Henn RE, Low DW, Storm PB. Occipital cervical fusion with a vascularized free fibular graft. Int J Spine Res 2019; 1 (01) 23-25
    CrossrefPubMedGoogle Scholar
  • 17 Minami A, Kaneda K, Satoh S, Abumi K, Kutsumi K. Free vascularised fibular strut graft for anterior spinal fusion. J Bone Joint Surg Br 1997; 79 (01) 43-47
    CrossrefPubMedGoogle Scholar
  • 18 Lee MJ, Ondra SL, Mindea SA, Fine NA, Dumanian GA. Indications and rationale for use of vascularized fibula bone flaps in cervical spine arthrodeses. Plast Reconstr Surg 2005; 116 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 19 Yelizarov VG, Minachenko VK, Gerasimov OR, Pshenisnov KP. Vascularized bone flaps for thoracolumbar spinal fusion. Ann Plast Surg 1993; 31 (06) 532-538
    CrossrefPubMedGoogle Scholar
  • 20 Davis JB, Taylor AN. Muscle pedicle bone grafts; experimental study. AMA Arch Surg 1952; 65 (02) 330-336
    CrossrefPubMedGoogle Scholar