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Updated: Feb 16, 2026
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Published on: August 13, 2017
Pedicled Vascularized Bone Grafts for Posterior Occipitocervical and Cervicothoracic Fusion: A Cadaveric Feasibility
Michael A Bohl1, Michael A Mooney1, Joshua S Catapano1
1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Background:
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.
Objective:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
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