Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
Reconstructive Plastic Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
Spine (Phila Pa 1976). 2017 Nov 1;42(21):E1266-E1271. doi: 10.1097/BRS.0000000000002150.
Cadaveric feasibility study.
To assess the anatomic and technical feasibility of rotating a clavicular segment on a sternocleidomastoid muscle (SCM) pedicle into the ventral cervical spine using a cadaveric model and to provide the first clinical case description of performing this procedure.
Reconstruction of the anterior cervical spine in patients with a high risk of pseudoarthrosis may require the use of a vascularized bone graft (VBG). A vascularized clavicular graft rotated on an SCM pedicle would afford all the benefits of a VBG without the added morbidity of free-tissue transfer; however, this technique has not been described.
A multidisciplinary team hypothesized that it would be anatomically and technically feasible to rotate a pedicled clavicular bone graft from the bottom of C2 to the top of T2 via an anterior approach. Five cadavers underwent bilateral anterior neck dissections for a total of 10 clavicular graft assessments. A case report describes the use of a clavicular VBG in a patient with a 3-level corpectomy defect and a history of failed fusion.
Ten clavicles were rotated on an SCM pedicle. The grafts were either harvested as an entire segment or as the superior two-thirds of clavicle, leaving the inferior one-third in situ with pectoralis attachments intact. All grafts reached from the bottom of C2 to the top of T2. When the entire length of exposed clavicle was mobilized, it could cover five to six levels. The case report highlights technical challenges of this procedure in a living patient and provides the clinical context for its potential utility in the reconstruction of the ventral cervical spine.
This surgical technique is best suited for patients with long-segment cervical defects and an increased risk of pseudarthrosis. Further clinical experience with this technique is required before definitive conclusions can be made.
尸体可行性研究。
评估使用尸体模型将锁骨段通过胸锁乳突肌（SCM）蒂旋转到颈椎腹侧的解剖学和技术可行性，并提供首例执行该手术的临床病例描述。
对于有假关节高风险的患者，重建前颈椎可能需要使用血管化骨移植物（VBG）。通过 SCM 蒂旋转的血管化锁骨移植物将提供所有 VBG 的益处，而不会增加游离组织转移的发病率；然而，这种技术尚未被描述。
一个多学科团队假设，通过前路从 C2 底部到 T2 顶部旋转带蒂锁骨骨移植物在解剖学和技术上是可行的。5 具尸体进行了双侧颈前解剖，总共评估了 10 个锁骨移植物。病例报告描述了在一名有 3 个节段椎体切除术缺陷和融合失败病史的患者中使用锁骨 VBG。
10 个锁骨通过 SCM 蒂旋转。移植物要么作为整个节段，要么作为锁骨的上三分之二被采集，留下下三分之一原位，胸大肌附着完整。所有移植物均从 C2 底部延伸至 T2 顶部。当整个暴露锁骨长度被移动时，它可以覆盖 5 到 6 个节段。病例报告突出了该手术在活体患者中的技术挑战，并为其在重建颈椎腹侧的潜在用途提供了临床背景。
该手术技术最适合长节段颈椎缺损和假关节高风险的患者。在得出明确结论之前，需要进一步的临床经验。
5 级。
