- Used for infant spine: This technique is useful for patients from infancy to approximately 18 months, in whom small anatomy and incomplete ossification prohibit not only screw placement but also sublaminar wiring.
- Autograft: Autograft is much preferable to allograft because it offers improved fusion. Iliac crest bone is used in older children and adolescents where only small graft size is required. Where strut grafts are required (e.g., occipito-cervical fusion in young children), then rib or full-thickness calvaria can be used.
Occipito-cervical fixation with calvarial bone graft: Two strips of full thickness calvarial bone graft are secured to the occiput and C2 lamina via cables.
- External bracing of fusion needed: This type of fusion requires an external orthosis for rigidity while the fusion is occurring.
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