928 Autologous Rib Graft for Posterior Cervical Fusion in Pediatrics: Efficacy and Complications

Abstract

INTRODUCTION: Cervical instability in the pediatric population presents unique challenges. Indication for fusion include instability or deformity from multiple causes. A recent meta-analysis showed high failure rate of successful arthrodesis after pediatric craniocervial fusion (over 30%). We describe use of autologous rib graft with BMP to augment fusion, evaluating efficacy and complication from this technique. METHODS: A retrospective study was performed between 2020 and 2023 of all pediatric patients (age 0-18) who underwent autologous rib grafting with extra-small BMP-2 for posterior craniocervical arthrodesis at a single institution. Patients with less than 3 month post-operative follow-up and no post operative CT were excluded. Primary outcomes include presence of fusion on CT, perioperative complication, and complication from rib harvest. RESULTS: Twenty-one patients met inclusion criteria. Ten were male, with average age 10 years (range 2 to 18). 87 total levels were fixated and fused, with no fixation screws misplaced on post operative CT. There were no surgical site infections, post operative seroma, or unplanned return to OR. All patients had solid fusion on postoperative CT. Average follow up was 268 days, with range of 45 days to 3 years. No patient had pain at the rib harvest on any post operative visit, and all rib incisions healed without complication. CONCLUSIONS: Our preliminary results suggest that autologous rib graft with extra-small BMP-2 is an effective strategy to achieve a high rate of fusion in pediatric patients undergoing posterior instrumented craniocervical fusion. In our series, we found an acceptable safety profile, with no seroma, surgical site infection, return to the OR, or rib harvest complication.