Pedicled,vascularized occipital bone graft to supplement atlantoaxial arthrodesis for the treatment of pseudoarthrosis |
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| Affiliation: | 1. Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA;2. Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA;3. Department of Neurosurgery, Barrow Neurological Institute, St. Joseph''s Hospital and Medical Center, Phoenix, AZ, USA;4. Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA;1. Dept of Neurosurgery, St George Hospital, Kogarah, NSW, Australia;2. Brain and Mind Centre, University of Sydney, NSW, Australia;3. Prince of Wales Clinical School, University of New South Wales, NSW, Australia;1. Neurosurgery Department, DFV Neuro, São Paulo, Brazil;2. Hospital Sírio Libanês, São Paulo, Brazil;3. Hospital Alemão Oswaldo Cruz, São Paulo, Brazil;1. The New York Institute of Technology College of Osteopathic Medicine, Glen Head, New York, USA;2. Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA;1. Division of Nephrology, Hypertension and Kidney Transplantation, University of Florida, Gainesville, FL, USA;2. Division of Urology, University of Florida, Gainesville, FL, USA |
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| 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. |
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| Keywords: | Atlantoaxial arthrodesis Pseudoarthrosis Revision spine surgery Transarticular fixation Vascularized bone grafts Suboccipital craniectomy |
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