title: Pedicled Vascularized Clavicular Graft for Anterior Cervical Arthrodesis: Cadaveric Feasibility Study, Technique Description, and Case Report.
abstract: METHODS
  Cadaveric feasibility study.
  
  
  OBJECTIVE
  To assess the anatomic and technical feasibility of rotating a clavicular segment on a sternocleidomastoid muscle (SCM) pedicle into the ventral cervical spine using a cadaveric model and to provide the first clinical case description of performing this procedure.
  
  
  BACKGROUND
  Reconstruction of the anterior cervical spine in patients with a high risk of pseudoarthrosis may require the use of a vascularized bone graft (VBG). A vascularized clavicular graft rotated on an SCM pedicle would afford all the benefits of a VBG without the added morbidity of free-tissue transfer; however, this technique has not been described.
  
  
  METHODS
  A multidisciplinary team hypothesized that it would be anatomically and technically feasible to rotate a pedicled clavicular bone graft from the bottom of C2 to the top of T2 via an anterior approach. Five cadavers underwent bilateral anterior neck dissections for a total of 10 clavicular graft assessments. A case report describes the use of a clavicular VBG in a patient with a 3-level corpectomy defect and a history of failed fusion.
  
  
  RESULTS
  Ten clavicles were rotated on an SCM pedicle. The grafts were either harvested as an entire segment or as the superior two-thirds of clavicle, leaving the inferior one-third in situ with pectoralis attachments intact. All grafts reached from the bottom of C2 to the top of T2. When the entire length of exposed clavicle was mobilized, it could cover five to six levels. The case report highlights technical challenges of this procedure in a living patient and provides the clinical context for its potential utility in the reconstruction of the ventral cervical spine.
  
  
  CONCLUSIONS
  This surgical technique is best suited for patients with long-segment cervical defects and an increased risk of pseudarthrosis. Further clinical experience with this technique is required before definitive conclusions can be made.
  
  
  METHODS
  5.
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Bohl
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mooney
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Catapano
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
authors.forename: Kaith K
authors.initials: KK
authors.lastname: Almefty
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Preul
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
authors.forename: Steve W
authors.initials: SW
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
authors.forename: U Kumar
authors.initials: UK
authors.lastname: Kakarla
authors.affiliation: Reconstructive Plastic Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ.|Arizona Center for Hand Surgery, Phoenix, AZ.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Reece
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
authors.forename: Jay D
authors.initials: JD
authors.lastname: Turner
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
authors.forename: Randall W
authors.initials: RW
authors.lastname: Porter
mesh_terms: D000368:Aged; D001174:Arthrodesis / Q000379:methods; D016025:Bone Transplantation / Q000379:methods*; D002102:Cadaver; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D002968:Clavicle / Q000000981:diagnostic imaging / Q000637:transplantation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D019547:Neck Pain / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*