Cite

Copy

Tap on and choose 'Add to Home Screen' to create a shortcut app

Tap on and choose 'Install/Install App' to create a shortcut app

Occipitocervical Fixation with Autologous Bone Graft for Craniocervical Instability Due to Metabolic Bone Disorders in Children

This page was last updated on May 9th, 2017

  • Used when bone cannot accommodate fixation devices: In the young child (less than 3 years of age) or in the context of some bone dysplasias where the bone quality is poor (e.g., mucopolysaccharidoses), rigid fixation to bone may not be possible. Onlay bone graft techniques supplemented by wires or cables are then indicated.

Bone graft sources

  • Rib: Rib is easy to harvest and readily available. In bone dysplasias rib quality may be poor and graft resorption can occur.
  • Fibula/tibia: Harvesting a graft from the fibula or tibia requires orthopedic expertise. Taking a graft from these bones may impair return to mobility after surgery.
  • Calvarial bone: Calvarial bone is easily harvested via a separate occipital incision. Calvarial bone readily regrows, and a full thickness graft can be used. The natural curve of the calvarium is suited to the occipitocervical lordosis

Wiring technique

  • Cables join occiput to cervical laminae: The bone graft is secured to the occiput and the cervical laminae with cables. Drill holes are placed in the occiput for passage of the cables. Care needs to be taken in passing sublaminar cables. A loop of suture can be passed beneath the lamina and the loop then used to pull through the cable. A single cable should not be passed under more than one lamina. 

CT sagittal reconstruction in a 4-year-old child with Morquio syndrome and progressive myelopathy: This is a image obtained preoperatively.

 

CT sagittal reconstruction after occipitocervical fusion: The image shown is 18 months after occipitocervical fixation with a calvarial bone graft.

 

 

Your donations keep us going

The ISPN Guide is free to use, but we rely on donations to fund our ongoing work and to maintain more than a thousand pages of information created to disseminate the most up-to-date knowledge in the field of paediatric neurosurgery.

By making a donation to The ISPN Guide you are also indirectly helping the many thousands of children around the world whose treatment depends on well-informed surgeons.

Please consider making a donation today.

Use the app

The ISPN Guide can be used as a standalone app, both on mobile devices and desktop computers. It’s quick and easy to use.

Fully featured

Free registration grants you full access to The Guide and host of featured designed to help further your own education.

Stay updated

The ISPN Guide continues to expand both in breadth and depth. Join our mailing list to stay up-to-date with our progress.