Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Oper Neurosurg (Hagerstown). 2021 Apr 15;20(5):502-507. doi: 10.1093/ons/opab036.
Obtaining successful arthrodesis at the craniocervical junction and atlantoaxial joint can be more challenging than in other segments of the cervical spine. This challenge stems from the relatively hypermobile joints between the occipital condyles, the motion that occurs at C1 and C2, as well as the paucity of dorsal bony surfaces for posterior arthrodesis. While multiple different techniques for spinal fixation in this region have been well described, there has been little investigation into auxiliary methods to improve fusion rates.
To describe the use of an occipital bone graft to augment bony arthrodesis in the supraaxial cervical spine using a multidisciplinary approach.
We review the technique for harvesting and placing a vascularized occipital bone graft in 2 patients undergoing revision surgery at the craniocervical junction.
The differentiation from nonvascularized bone graft, either allograft or autograft, to a bone graft using vascularized tissue is a key principle of this technique. It has been well established that vascularized bone heals and fuses in the spine better than structural autogenous grafts. However, the morbidity and added operative time of harvesting a vascularized flap, such as from the fibula or rib, precludes its utility in most degenerative spine surgeries.
By adapting the standard neurosurgical procedure for a suboccipital craniectomy and utilizing the tenets of flap-based reconstructive surgery to maintain the periosteal and muscular blood supply, we describe the feasibility of using a vascularized and pedicled occipital bone graft to augment instrumented upper cervical spinal fusion. The use of this vascularized bone graft may increase fusion rates in complex spine surgeries.
颅颈交界区和寰枢关节获得成功的融合比颈椎其他节段更具挑战性。这一挑战源于枕骨髁之间相对活动度较大的关节、C1 和 C2 之间的运动以及用于后路融合的背侧骨面相对较少。虽然该区域的多种不同脊柱固定技术已有详细描述，但对于提高融合率的辅助方法的研究甚少。
描述使用枕骨骨移植物通过多学科方法来增强上颈椎脊柱的骨性融合。
我们回顾了在 2 例颅颈交界区翻修手术中采集和放置带血管枕骨骨移植物的技术。
将带血管组织的骨移植物与非血管化骨移植物（同种异体或自体）区分开来是该技术的关键原则。已经充分证实，带血管的骨在脊柱中的愈合和融合效果优于结构性自体移植物。然而，采集血管化皮瓣（如腓骨或肋骨）的发病率和增加的手术时间使其在大多数退行性脊柱手术中无法应用。
通过适应枕下颅骨切除术的标准神经外科手术，并利用基于皮瓣的重建手术原则来维持骨膜和肌肉的血液供应，我们描述了使用带血管蒂的枕骨骨移植物来增强器械化上颈椎融合的可行性。在复杂的脊柱手术中使用这种带血管骨移植物可能会提高融合率。
