Clavicular Autograft for C7–T1 Anterior Spinal Fusions

Abstract

Background Arthrodesis to anterior cervical spine fusion (ACSF) following trauma remains an effective method to accomplish both vertebrae link and neural decompression using combined materials such as metal screws and plates, along a section of bone inserted between the two adjacent involved vertebrae plates, conferring reliable spinal stability. Present study shows an alternative technique using autologous ipsilateral clavicle bone graft to fracture disruptions localized at most inferior aspect of cervical spine.

Methods Five adult patients with C7–T1 fracture dislocations were treated by means of clavicular autograft to promote neural decompression and vertebral fusion. An anterior cervical supramanubrial approach was performed in all patients to perform a standard surgical approach and dissection to the anterior cervical spine.

Results No gross injury was found to adjacent structures, the middle one-third of the clavicle offered sufficient bone for the one to two segments fused with the remaining bone for at least two additional segments, and a convenient bone healing fusion was observed 3 to 6 months after the procedure, without local or regional complications from the technique.

Conclusion Autologous clavicle may be a suitable alternative to the iliac crest for use in anterior cervical fusion procedures with a convenient bone healing fusion.

Resumo

Introdução A artrodese de coluna cervical é um método eficaz para fixação vertebral e para descompressão neural, utilizando materiais como parafusos, placas de metal e um enxerto ósseo inserido entre as duas placas fixadas nas vértebras adjacentes, conferindo estabilidade para a coluna vertebral. O presente estudo mostra uma técnica alternativa que utiliza enxerto ósseo autólogo da clavícula ipsilateral a fraturas localizadas no segmento mais inferior da coluna cervical.

Métodos Cinco pacientes adultos com fraturas e luxações de C7-T1 foram tratados por meio de enxerto clavicular autólogo, com o intuito de promover a descompressão neural e fusão vertebral. Uma abordagem supramanubrial cervical anterior foi realizada em todos os pacientes, objetivando uma abordagem cirúrgica padrão e dissecção para a coluna cervical anterior.

Resultados Não houve lesão de estruturas adjacentes, o terço médio da clavícula utilizado foi suficiente para a fixação óssea do segmento inferior da coluna cervical, adequada fusão óssea foi observada 3-6 meses após o procedimento. Não houve complicações locais decorrentes da técnica.

Conclusões Enxerto clavicular autólogo pode ser uma alternativa à crista ilíaca em procedimentos de fusão cervical anterior, com fixação cervical adequada e poucas complicações.

Keywords

cervical vertebrae - column - arthrodesis - spinal fractures

Palavras-chave

vértebras cervicais - coluna - artrodese da coluna vertebral - fraturas

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