Faculty Collaboration Database

Pedicled, vascularized occipital bone graft to supplement atlantoaxial arthrodesis for the treatment of pseudoarthrosis. J Clin Neurosci 2020 Apr;74:205-209

Date

05/01/2019

Pubmed ID

31036507

DOI

10.1016/j.jocn.2019.04.014

Scopus ID

2-s2.0-85064606493 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

Atlantoaxial pseudoarthrosis is a challenging postoperative complication. The use of a local, vascularized bone graft, without free tissue transfer, to support a revision atlantoaxial fusion has not been previously described. We report the first surgical patient who received a semispinalis capitis muscle pedicled, occipital bone graft for supplementation of a revision atlantoaxial arthrodesis. A 72-year-old female had a failed atlantoaxial fusion and developed neck pain from continued instability and fractured hardware. The fixation and fusion were revised and supplemented with a novel, pedicled occipital bone graft. A craniectomy was performed in the occipital bone while still attached to the semispinalis capitis muscle to provide graft vascularity. This graft was rotated inferiorly from the skull base to the C1 arch and C2 spinous process in order to supplement a revision atlantoaxial arthrodesis. The patient had excellent clinical recovery over 18-month clinical follow up. The bone graft harvesting and rotation were performed safely and without complication. The 6-month postoperative CT scan showed partial fusion into the graft. This novel surgical technique leverages the advantages of vascularized structural autograft without adding extensive time or morbidity to the procedure as observed in free-tissue transfers. It is a safe and useful salvage technique to supplement revision atlantoaxial fusion surgeries.

Author List

Reece EM, Vedantam A, Lee S, Bhadkamkar M, Kaufman M, Bohl MA, Chang SW, Porter RW, Theodore N, Kakarla UK, Ropper AE

Author

Aditya Vedantam MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Atlanto-Axial Joint
Bone Transplantation
Female
Humans
Occipital Bone
Postoperative Complications
Pseudarthrosis
Reoperation
Spinal Fusion
Surgical Flaps