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Periosteal turndown flap for posterior occipitocervical fusion: a technique review

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Abstract

Purpose

Recently, several authors have proposed techniques for improving the fusion rate in pediatric posterior occipitocervical fusion including a variety of implants and the use of bone morphogenetic protein. A technique by Koop et al. using a periosteal flap for occipitocervical arthrodesis was described in 1984.

Methods

A straight incision is made about the posterior neck to expose the occipitocervical region from the inion superiorly to the lowest cervical vertebrae to be fused inferiorly. The occiput is exposed superficial to the periosteum, which is then reflected and elevated from the occiput. The attachment is preserved at the caudal base of the flap and reflected over the intended area of fusion. When possible, fixation is then performed with cables, wires, screws, hooks, or plates.

Case example

A 6-year-old male with an occiput to C2 distraction injury underwent posterior spinal fusion from occiput to C3 using sublaminar wires, periosteal turndown flap, and autologous iliac crest bone graft.

Conclusion

In small children with traumatic upper cervical spine instability, the periosteal turndown technique may be used as a safe adjunct for occipitocervical fusions.

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Acknowledgements

All figures and tables in this manuscript are used with permission of the Children’s Orthopaedic Center, Los Angeles.

Author information

Authors and Affiliations

  1. Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA, 90033, USA

    Siamak Yasmeh & Adrienne Quinn

  2. Children’s Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA

    Liam Harris, Austin E. Sanders, Ted Sousa, David L. Skaggs & Lindsay M. Andras

Authors
  1. Siamak Yasmeh
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  2. Adrienne Quinn
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  3. Liam Harris
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  4. Austin E. Sanders
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  5. Ted Sousa
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  6. David L. Skaggs
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  7. Lindsay M. Andras
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Corresponding author

Correspondence to David L. Skaggs.

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Conflict of interest

DLS (reports personal fees from ZimmerBiomet, Grand Rounds, Medtronic, Orthobullets, Zipline Medical Inc., Green Sun Medical, Biomet Spine, Johnson & Johnson, and Wolters Kluwer Health-Lippincott Williams & Wilkins; nonfinancial support from Growing Spine Foundation, Growing Spine Study Group, Scoliosis Research Society, Orthobullets; other from Zipline Medical Inc.; research grants from Pediatric Orthopaedic Society of North America, Scoliosis Research Society (Paid to Columbia University), Ellipse (Co-PI, Paid to Growing Spine Foundation), outside the submitted work).

LMA (reports personal fees from Biomet, Medtronic, and Orthobullets; other from Eli Lilly; nonfinancial support from Pediatric Orthopaedic Society of North America and Scoliosis Research Society, Journal of Pediatric Orthopedics, outside the submitted work).

Ethical approval

This study has been carried out with approval from the Committee on Clinical Investigations at Children’s Hospital Los Angeles.

Funding

None of the authors received financial support for this study.

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Yasmeh, S., Quinn, A., Harris, L. et al. Periosteal turndown flap for posterior occipitocervical fusion: a technique review. Eur Spine J 26, 2303–2307 (2017). https://doi.org/10.1007/s00586-017-5085-8

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  • DOI: https://doi.org/10.1007/s00586-017-5085-8

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