A Modified Method for Occipitocervical Fusion Utilizing Compressed Iliac Crest Allograft Leads to a Excessive Fee of Fusion within the Pediatric Inhabitants.
World Neurosurg. 2017 Nov;107:342-350
Authors: Iyer RR, Tuite GF, Meoded A, Carey CC, Rodriguez LF
BACKGROUND: In kids, excessive charges of occipitocervical (OC) fusion have been demonstrated with the usage of inflexible instrumentation together with harvested autograft, with or with out bone morphogenetic protein (BMP). Traditionally, the usage of allograft supplies demonstrated inferior OC fusion outcomes in contrast with autograft. Nevertheless, autograft harvest harbors an elevated danger of affected person morbidity, and the usage of BMP is dear and controversial in kids. Thus, there stays a necessity for safer, less expensive, but efficacious strategies for OC fusion within the pediatric inhabitants.
METHODS: We retrospectively reviewed the charts of sufferers youthful than 21 years of age who underwent OC fusion with structural allograft placement at our establishment from 2010 to 2015. Knowledge collected included age, intercourse, follow-up period, fusion outcomes, and postoperative issues.
RESULTS: A complete of 19 sufferers (eight feminine and 11 male) underwent OC fusion with our surgical approach. Imply age was eight.5 ± four.three years. Radiographic comply with up information have been out there for 18 of 19 sufferers. One affected person was misplaced to medical comply with up however had radiographic affirmation of fusion. Thus, 18 of 18 (100%) of sufferers with radiographic follow-up achieved profitable arthrodesis as decided by computed tomography. Median period to documented fusion was four.5 months. Medical follow-up was out there for 17 of 19 sufferers and was on common 18.eight ± 13.5 months. One affected person required reoperation for graft fracture eight months after radiographic affirmation of profitable fusion. There have been no vertebral artery accidents or different postoperative issues.
CONCLUSIONS: We display a modified approach for OC fusion in kids with distinctive structural allograft shaping and affixation, resulting in wonderful fusion outcomes at comply with up. This method obviates the necessity for autograft harvest or BMP, and should lower postoperative morbidity.
PMID: 28790003 [PubMed – indexed for MEDLINE]