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Review
. 2021 Feb;35(1):14-19.
doi: 10.1055/s-0041-1723834. Epub 2021 May 10.

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

Sebastian J Winocour  1 , Erica Y Xue  1   2 , Michael A Bohl  3 , Farrokh Farrokhi  4 , Matthew J Davis  1   2 , Amjed Abu-Ghname  1   2 , Alexander E Ropper  5 , Edward M Reece  1   2   5
Affiliations
Review

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

Sebastian J Winocour et al. Semin Plast Surg. 2021 Feb.

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: autograft; occipital graft; spinal fusion; spinoplastic reconstruction; vascularized bone graft.

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Conflict of interest statement

Conflicts of Interest Dr. Ropper receives consulting fees from Globus Medical and Stryker. All authors, including Dr. Ropper, have no financial interests in relation to the content of this article.

Figures

Fig. 1
Fig. 1
Illustration of the pedicled, vascularized occipital bone graft. The vascularized bone graft is pedicled on the splenius capitis muscle and rotated in between the C1 and C2 lamina to augment arthrodesis. (Reprinted with permission from Scott Holmes, CMI, Baylor College of Medicine.)
Fig. 2
Fig. 2
Intraoperative photograph showing the harvesting of the occipital bone graft. The cuts of the craniectomy are visible. The lateral border of the intact muscle pedicle is exposed with the dissector.
Fig. 3
Fig. 3
Intraoperative photograph of a cervical spine instrumented fusion. The muscle pedicle is intact (^) and the occipital bone graft (*) is held in place across the C1 and C2 lamina with a cross-connector to apply compression.
Fig. 4
Fig. 4
Postoperative computed tomography reconstruction of the patient 3 (left) and 6 months (right) following occipital bone graft fusion augmentation showing partial fusion from C1 to C2.
Fig. 5
Fig. 5
Postoperative computed tomography reconstruction of a patient 10 months following occipital bone graft fusion augmentation. There is solid fusion from the cranium to the C2 lamina.
See this image and copyright information in PMC

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