A technique of occipitocervical arthrodesis in children using autologous rib grafts

Study Design. Description of an operative technique with an illustrative ca se report. Objectives. The technique is presented to provide an alternative to iliac c rest graft procedures for achieving occipitocervical fusion in children. Th is technique is particularly useful in children with instability after exte nsive decompression or laminectomy and in children with a large protuberant occiput. Summary of Background Data. The majority of techniques previously described for occipitocervical fusion in children rely on corticocancellous iliac cr est autograft. Results generally have been promising; however, it can be di fficult to harvest enough graft to span large defects after extensive decom pression or to contour an iliac crest graft to a protuberant occiput. Struc tural rib autograft is superior in terms of availability and its unique and modifiable contour. Theoretical benefits of rib graft include superior str ength and lower donor site morbidity. Methods. The surgical technique is described. A case of a 2-year-old boy wi th Down's syndrome and myelopathy secondary to cervical instability is revi ewed. Results. The patient underwent occipitocervical arthrodesis using the techn ique described. The child made a full neurologic recovery, and at the 2-yea rs follow-up evaluation, the graft had incorporated and the spine was stabl e. Conclusion. A technique of occipitocervical arthrodesis in children is desc ribed using autologous rib graft. This procedure was designed to span large defects or to deal with a large protuberant occiput; however, it is also u seful for less demanding cases and may offer several advantages compared wi th procedures relying on iliac crest graft.