Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Reconstructive Plastic Surgery, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Oper Neurosurg (Hagerstown). 2018 Sep 1;15(3):318-324. doi: 10.1093/ons/opx258.
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.
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.
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.
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.
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.
关节融合术对于实现重建脊柱手术的良好结果至关重要。血管化骨移植物（VBG）已成功用于提高多种骨骼病变的融合率，带蒂 VBG 比游离转移 VBG 具有许多优势。带蒂 VBG 以前尚未用于后枕骨颈椎胸椎。
使用尸体模型确定、描述和评估从枕骨到 T12 的带蒂 VBG 的潜在供体部位，并描述移植物采集和放置的重要技术注意事项。
一个由整形外科医生和神经外科医生组成的多学科团队假设，通过后路旋转带蒂 VBG 从枕骨到 T12 是可行的。在 6 具尸体中，确定了 3 个解剖上可行的 VBG 供体部位：枕骨、肩胛骨和肋骨。
半棘肌蒂上的分割和全厚枕骨 VBG 被动员。枕骨 VBG 可以从枕骨动员到 T1 并跨越多达 4 个水平。肩胛 VBG 在肩胛下蒂上动员，可以从枕骨动员到 T7 并跨越多达 8 个水平。肋 VBG 在肋下蒂上动员，可以从 C6 动员到 T12。肋骨 T2 到 T4 和 T11 到 T12 可以覆盖 2 个水平，肋骨 T5 到 T10 可以覆盖 3 个水平。第一肋骨由于其主要的腹侧走向，在解剖上不适合作为 VBG。
带蒂 VBG 可以从枕骨到 T12 应用于后路脊柱融合术。有非融合高风险的患者可能会从这种策略中受益。
