scholarly journals Vascularized Occipital Bone Grafting: Indications, Techniques, Clinical Outcomes, and Alternatives

2021 ◽  
Vol 35 (01) ◽  
pp. 014-019
Author(s):  
Sebastian J. Winocour ◽  
Erica Y. Xue ◽  
Michael A. Bohl ◽  
Farrokh Farrokhi ◽  
Matthew J. Davis ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Craniocervical Junction ◽  
Upper Cervical Spine ◽  
Atlantoaxial Joint ◽  
Spinal Fixation ◽  
Relative Ease ◽  
Novel Technique ◽  
Upper Cervical ◽  
Increased Strength ◽  
Vascularized Bone

AbstractSuccessful arthrodesis at the craniocervical junction and atlantoaxial joint can be more challenging than in other segments of the cervical spine. Different techniques for spinal fixation in this region have been well described, along with auxiliary methods to improve fusion rates. The occipital vascularized bone graft is a novel technique that can be used to augment bony arthrodesis in the supra-axial cervical spine. It provides the benefits of a vascularized autologous graft, such as accelerated healing, earlier fusion, and increased strength. This technique can be learned with relative ease and may be particularly helpful in cases with high risk of nonunion or pseudoarthrosis in the upper cervical spine.

Vascularized Bone Grafts for Spinal Fusion—Part 3: The Occiput

2021 ◽  
Author(s):  
Michael A Bohl ◽  
Edward M Reece ◽  
Farrokh Farrokhi ◽  
Matthew J Davis ◽  
Amjed Abu-Ghname ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Bone Graft ◽  
Spinal Fusion ◽  
Craniocervical Junction ◽  
Occipital Bone ◽  
Atlantoaxial Joint ◽  
Suboccipital Craniectomy ◽  
Upper Cervical ◽  
Posterior Arthrodesis ◽  
Vascularized Bone

Abstract BACKGROUND 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. OBJECTIVE To describe the use of an occipital bone graft to augment bony arthrodesis in the supraaxial cervical spine using a multidisciplinary approach. METHODS We review the technique for harvesting and placing a vascularized occipital bone graft in 2 patients undergoing revision surgery at the craniocervical junction. RESULTS 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. CONCLUSION 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.

scholarly journals Subarachnoid Hematoma of the Craniocervical Junction and Upper Cervical Spine After Traumatic Cerebral Contusion: Case Report

2013 ◽  
Vol 53 (9) ◽  
pp. 620-624 ◽  
Author(s):  
Alessandro DI RIENZO ◽  
Maurizio IACOANGELI ◽  
Lorenzo ALVARO ◽  
Roberto COLASANTI ◽  
Elisa MORICONI ◽  
...  
Keyword(s):  
Case Report ◽  
Cervical Spine ◽  
Craniocervical Junction ◽  
Upper Cervical Spine ◽  
Cerebral Contusion ◽  
Upper Cervical

scholarly journals Upper Cervical Spine Stability: Maximum Rotation and the Rotation Stress Test in Clinics

2019 ◽  
Vol 7 ◽  
Author(s):  
Ana I Lorente ◽  
Mario Maza Frechín ◽  
Albert Pérez Bellmunt ◽  
César Hidalgo García
Keyword(s):  
Cervical Spine ◽  
Stress Test ◽  
Craniocervical Junction ◽  
Upper Cervical Spine ◽  
Spine Stability ◽  
Upper Cervical ◽  
Rotation Stress

The rotation stress test is used to evaluate stability of the craniocervical junction by assuming that it gives the maximum rotation. However, a more complex manipulation might show a higher rotation: the rotation with extension and contralateral bending. This was tested in vitro with ten upper cervical spine specimens.

scholarly journals Pseudogout of the Transverse Atlantal Ligament: An Unusual Cause of Cervical Myelopathy

2004 ◽  
Vol 31 (2) ◽  
pp. 273-275 ◽  
Author(s):  
Donald E.G. Griesdale ◽  
Mike Boyd ◽  
Ramesh L. Sahjpaul
Keyword(s):  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Healthy Woman ◽  
Cord Compression ◽  
Calcium Pyrophosphate ◽  
Craniocervical Junction ◽  
Upper Cervical Spine ◽  
Calcium Pyrophosphate Dihydrate ◽  
Upper Cervical ◽  
Pyrophosphate Dihydrate

AbstractBackground:Calcium pyrophosphate dihydrate deposition in the cervical spine is infrequently symptomatic. This is especially true at the craniocervical junction and upper cervical spine.Case Report:A 70-year-old previously healthy woman presented with a progressive cervical myelopathy of four months duration.Results:Examination revealed sensorimotor findings consistent with an upper cervical myelopathy. Radiological studies (plain radiographs, computed tomography, and magnetic resonance imaging) revealed C1-2 instability, and a well-defined extradural 3cm x 1cm retro-odontoid mass causing spinal cord compression. Transoral resection of the mass was performed followed by posterior C1-2 stabilization. Histological examination of the mass confirmed calcium pyrophosphate dihydrate deposition. Follow-up examination showed marked clinical and radiological improvement.Conclusion:Although uncommon, calcium pyrophosphate dihydrate deposition disease should be considered in the differential diagnosis of extradural mass lesions in the region of the odontoid.

scholarly journals Cervicogenic Headache and the Relationship Between the Position and Movement of the Upper Cervical Spine and Dura

2020 ◽  
Author(s):  
Rob Sillevis ◽  
Eric Shamus ◽  
Karen Wyss
Keyword(s):  
Cervical Spine ◽  
Physical Therapist ◽  
Control Group ◽  
Upper Cervical Spine ◽  
Atlantoaxial Joint ◽  
Convenience Sample ◽  
Slump Test ◽  
Significant Difference ◽  
Cervicogenic Headaches ◽  
Upper Cervical

Abstract Background: It has been demonstrated that cervicogenic headaches (CGH) is caused by dysfunction of the upper cervical spine. Due the soft tissue connection between muscle, cervical fascia and dura, this region might contribute to the development of CGH’s. This study evaluated if subjects with CGH have concurrent neural tension signs. The secondary aim of this study was to investigate if there is a correlation between the position of atlas and mobility of atlantoaxial joint in those experiencing cervicogenic headaches compared to a healthy control group.Methods: A convenience sample of 60 subjects were recruited for this study. Each subjected completed self-reported outcome measures, after which the passive neck flexion rotation test, upper limb tension test (ULTT), slump test, and straight leg raise test (SLR) was performed by the physical therapist.Outcomes: There was a significant difference in the passive atlantoaxial rotation to the right between the CGH and the control group p = 0.025. There was a no statistically significance in left rotation. There was no significant relationship between CGH and the ULTT, slump ad SLR with P > 0.05. The position of atlas was significantly related with CGH with P < 0.001 and position of atlas was significantly related to AA motion with p < 0.001Discussion: The results of this study demonstrate that there is a direct relationship between the position of atlas, unilateral restriction in AA rotation, and the presence of CGH’s. The presence of fascial connections between structures of the high cervical spine and the dura motion could result in dural tension and should be considered by physical therapists when managing patients with CGH. The use of the ULTT, Slump test, and SLR test do not appear beneficial identifying those with CGH.

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