title: Craniovertebral fusion in an infant using struts of banked adult bone.
abstract: OBJECTIVE
  The aim of this paper is to discuss the problems of craniocervical instability and craniocervical fusion in infancy. Despite the relative frequency of carniovertebral joint malformations, actual instability is quite rare in infancy.
  
  
  METHODS
  An infant 8 months of age presented with tetraparesis and sleep apnea due to a complex malformation of her craniovertebral joint. An initial attempt at conservative treatment using a rigid neck collar failed, so the patient was surgically managed by the onlay placement of two autologous rib grafts. The rigid collar was maintained for 5 months.
  
  
  RESULTS
  Both rib grafts progressively reabsorbed within a few months, while the clinical deficits recurred. Reoperation consisted of occipitocervical interposition of two robust struts of banked cadaveric adult fibula. This time, the skull appeared mature enough to allow immobilization by the halo system. Adequate occipitocervical fusion was eventually achieved, and the patient fully recovered.
  
  
  CONCLUSIONS
  To the best of our knowledge, there is no other reported case of an infant undergoing craniovertebral fusion using cadaveric adult bone. When screw placement is not considered advisable to manage small infants, appropriate stability may be obtained using struts of robust cadaveric bone. A meticulous carpentry technique with graft interposition under compression and adequate postoperative immobilization remains mandatory.
authors.affiliation: Department of Neurosurgery, Niguarda Ca'Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy. tala_nch@yahoo.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Talamonti
authors.affiliation: Department of Neurosurgery, Niguarda Ca'Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Aliberti
authors.affiliation: Department of Neurosurgery, Niguarda Ca'Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Debernardi
mesh_terms: D001268:Atlanto-Axial Joint / Q000601:surgery; D001863:Bone Screws; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008279:Magnetic Resonance Imaging; D020758:Spinal Cord Vascular Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D015898:Tomography Scanners, X-Ray Computed
keywords: Bone graft; Cadaveric bone; Craniovertebral fusion; Craniovertebral instability; Craniovertebral junction malformations