Pedicled Vascularized Bone Grafts for Posterior Occipitocervical and Cervicothoracic Fusion: A Cadaveric Feasibility Study

Abstract

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.

Bone Grafts, Bone Substitutes, and Orthobiologics: Applications in Plastic Surgery

“…The ideal bone grafts for this application combine healing with restoration of segment mobility. Vascularized bone grafting has shown promise in augmenting fusion in the setting of a variety of skeletal pathologies, with its applicability explored in cervical arthrodesis, 12 occipitocervical and cervicothoracic fusion, 73 lumbar fusion, 74 lumbar osteodiscitis, 75 and lumbosacral fusion. 76 In patients who require long-segment ventral cervical reconstruction, arthrodesis can be achieved with a pedicled clavicular graft that provides the benefits of a vascularized free fibula without the added morbidity of a free tissue transfer.…”

“…Split and full-thickness occipital vascularized bone grafts can be mobilized on a semispinalis pedicle from the occiput toT1, spanning up to four levels. 73 Scapular vascularized bone grafts can be mobilized from the occiput to T7, spanning up to eight levels, and rib vascularized bone grafts can be mobilized from C6 to T12. 73 In contrast to the traditional posterior open approach for lumbar spine reconstruction, rotation of a vascularized spinous process graft to augment posterolateral arthrodesis adds mere minutes to total operative time, while limiting morbidity and providing for improved spinal fusion in as little as 3 months postoperatively.…”

“…73 Scapular vascularized bone grafts can be mobilized from the occiput to T7, spanning up to eight levels, and rib vascularized bone grafts can be mobilized from C6 to T12. 73 In contrast to the traditional posterior open approach for lumbar spine reconstruction, rotation of a vascularized spinous process graft to augment posterolateral arthrodesis adds mere minutes to total operative time, while limiting morbidity and providing for improved spinal fusion in as little as 3 months postoperatively. 74 It has been well established that recurrent infection contributes to failed spinal fusion, and in patients with this susceptibility as well as other risk factors for pseudarthrosis, vascularized autograft can be used to accommodate posterior, anterior, and lateral surgical approaches for lumbar debridement, fixation, and fusion.…”

Vascularized Scapular Bone Grafting: Indications, Techniques, Clinical Outcomes, and Alternatives

“…4,14 Overall, these advantages lead to higher and faster rates of bony fusion, decreased susceptibility to infection, and a decreased risk of pseudarthrosis. 15 Free-transfer bone flaps also possess these same advantages over N-VBGs. One common type of free-transfer bone flap is as a free fibula bone flap.…”

“…For example, free-transfer procedures may have increased donor site morbidity, increased operative times, and therefore increased anesthesia times secondary to positioning challenges or technical difficulty, as well as increased blood loss. 15 These issues can be circumvented by using a VBG, which is a locally harvested bone segment that maintains its blood supply via muscle, is directly supplied by periosteal feeding vessels, and can be rotated into the spinal fusion bed. 2,15 This pedicled method avoids the need for microsurgery, thereby decreasing the potential complexity, blood loss, donor site morbidity, and operative time associated with free-transfer bone flaps.…”