title: A technique of occipitocervical arthrodesis in children using autologous rib grafts.
abstract: METHODS
  Description of an operative technique with an illustrative case report.
  
  
  OBJECTIVE
  The technique is presented to provide an alternative to iliac crest graft procedures for achieving occipitocervical fusion in children. This technique is particularly useful in children with instability after extensive decompression or laminectomy and in children with a large protuberant occiput.
  
  
  BACKGROUND
  The majority of techniques previously described for occipitocervical fusion in children rely on corticocancellous iliac crest autograft. Results generally have been promising; however, it can be difficult to harvest enough graft to span large defects after extensive decompression or to contour an iliac crest graft to a protuberant occiput. Structural rib autograft is superior in terms of availability and its unique and modifiable contour. Theoretical benefits of rib graft include superior strength and lower donor site morbidity.
  
  
  METHODS
  The surgical technique is described. A case of a 2-year-old boy with Down's syndrome and myelopathy secondary to cervical instability is reviewed.
  
  
  RESULTS
  The patient underwent occipitocervical arthrodesis using the technique described. The child made a full neurologic recovery, and at the 2-years follow-up evaluation, the graft had incorporated and the spine was stable.
  
  
  CONCLUSIONS
  A technique of occipitocervical arthrodesis in children is described using autologous rib graft. This procedure was designed to span large defects or to deal with a large protuberant occiput; however, it is also useful for less demanding cases and may offer several advantages compared with procedures relying on iliac crest graft.
authors: Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
authors: M W
authors: MW
authors: Cohen
authors: D S
authors: DS
authors: Drummond
authors: J M
authors: JM
authors: Flynn
authors: S G
authors: SG
authors: Pill
authors: J P
authors: JP
authors: Dormans
mesh_terms: D001174:Arthrodesis / Q000379:methods; D002574:Cervical Vertebrae / Q000601:surgery*; D002669:Child Welfare; D002675:Child, Preschool; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D008297:Male; D009777:Occipital Bone / Q000601:surgery*; D012272:Ribs / Q000637:transplantation*; D013123:Spinal Fusion / Q000379:methods*; D014182:Transplantation, Autologous / Q000706:statistics & numerical data*