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. 2018 Sep 1;15(3):318-324.
doi: 10.1093/ons/opx258.

Pedicled Vascularized Bone Grafts for Posterior Occipitocervical and Cervicothoracic Fusion: A Cadaveric Feasibility Study

Michael A Bohl  1 , Michael A Mooney  1 , Joshua S Catapano  1 , Kaith K Almefty  1 , Jay D Turner  1 , Steve W Chang  1 , Mark C Preul  1 , Edward M Reece  2   3 , U Kumar Kakarla  1
Affiliations

Pedicled Vascularized Bone Grafts for Posterior Occipitocervical and Cervicothoracic Fusion: A Cadaveric Feasibility Study

Michael A Bohl et al. Oper Neurosurg. .

Abstract

Background: Arthrodesis is critical for achieving favorable outcomes in reconstructive spine surgery. Vascularized bone grafts (VBGs) have been successfully used to augment fusion rates in a variety of skeletal pathologies, and pedicled VBG has numerous advantages over free transfer VBG. Pedicled VBG has not previously been described for the posterior occipitocervicothoracic spine.

Objective: To identify, describe, and assess potential donor sites for pedicled VBGs from occiput to T12 using a cadaver model and to describe important technical considerations for graft harvest and placement.

Methods: A multidisciplinary team of plastic surgeons and neurosurgeons hypothesized that it is feasible to rotate a pedicled VBG from the occiput to T12 via a posterior approach. In 6 cadavers, 3 VBG donor sites were identified as anatomically feasible: occiput, scapula, and rib.

Results: Split- and full-thickness occipital VBGs were mobilized on a semispinalis pedicle. Occipital VBGs could be mobilized from occiput to T1 and span up to 4 levels. Scapular VBGs were mobilized on a subscapular pedicle and could be mobilized from occiput to T7 and span up to 8 levels. Rib VBGs were mobilized on subcostal pedicles and could be mobilized from C6 to T12. Ribs T2 to T4 and T11 and T12 could cover 2 levels, and ribs T5 to T10 could cover 3 levels. The first rib was anatomically unsuitable as a VBG due to its primarily ventral course.

Conclusion: Pedicled VBGs can feasibly be applied to posterior spinal arthrodesis from occiput to T12. Patients at high risk for nonunion may benefit from this strategy.

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