Pedicled, vascularized occipital bone graft to supplement atlantoaxial arthrodesis for the treatment of pseudoarthrosis

Edward M. Reece, Aditya Vedantam, Sungho Lee, Mohin Bhadkamkar, Matthew Kaufman, Michael A. Bohl, Steve W. Chang, Randall W. Porter, Nicholas Theodore, U. Kumar Kakarla, Alexander E. Ropper

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Atlantoaxial pseudoarthrosis is a challenging postoperative complication. The use of a local, vascularized bone graft, without free tissue transfer, to support a revision atlantoaxial fusion has not been previously described. We report the first surgical patient who received a semispinalis capitis muscle pedicled, occipital bone graft for supplementation of a revision atlantoaxial arthrodesis. A 72-year-old female had a failed atlantoaxial fusion and developed neck pain from continued instability and fractured hardware. The fixation and fusion were revised and supplemented with a novel, pedicled occipital bone graft. A craniectomy was performed in the occipital bone while still attached to the semispinalis capitis muscle to provide graft vascularity. This graft was rotated inferiorly from the skull base to the C1 arch and C2 spinous process in order to supplement a revision atlantoaxial arthrodesis. The patient had excellent clinical recovery over 18-month clinical follow up. The bone graft harvesting and rotation were performed safely and without complication. The 6-month postoperative CT scan showed partial fusion into the graft. This novel surgical technique leverages the advantages of vascularized structural autograft without adding extensive time or morbidity to the procedure as observed in free-tissue transfers. It is a safe and useful salvage technique to supplement revision atlantoaxial fusion surgeries.

Original languageEnglish (US)
Pages (from-to)205-209
Number of pages5
JournalJournal of Clinical Neuroscience
StatePublished - Apr 2020


  • Atlantoaxial arthrodesis
  • Pseudoarthrosis
  • Revision spine surgery
  • Suboccipital craniectomy
  • Transarticular fixation
  • Vascularized bone grafts

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology
  • Physiology (medical)


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