The use of autologous skull bone grafts for posterior fusion of the upper cervical spine in children.

Abstract

Traditionally bone grafts used in posterior cervical fusion have been harvested from the iliac crest, rib, tibia, or fibula. Their use is not without significant morbidity, and it is often difficult to harvest suitable quantities of good quality bone in children. We have used autologous calvarial bone secured by sublaminar wires in seven patients with congenital spinal anomalies to achieve craniocervical stabilization and fusion. To detail our experiences with this new method of harvesting autologous bone grafts from the patient's skull for occipitocervical fusion in a pediatric practice. Calvarial bone has been used extensively in craniofacial reconstructive work with good long-term results and with no significant bone resorption. The use of membranous bone is supported by several basic science studies reported in the plastic surgery literature that claim a superiority over endochondral bone regarding fusion. In the present study, autologous calvarial bone has been used in the treatment of seven cases of congenital upper cervical spine instability associated with neurologic deficit. This method circumvents many of the problems attached to the use of traditional donor sites and provides good quality bone in large quantity that can be specifically tailored to match the contours of the craniocervical junction. We used autologous calvarial bone secured by sublaminar wires in seven children with congenital spinal anomalies to achieve craniocervical stabilization and fusion. The ensuing calvarial defect was repaired using split-thickness parietal bone with the bone graft, which was ultimately used for the cervical fusion and acted as a template to obtain a mirror image and exact match to achieve good cosmetic results. The patients were immobilized after surgery in a halo orthosis for 3 months. Satisfactory results (100% fusion) were achieved in all seven cases with no attendant morbidity related to the method of graft procurement. We recommend this technique as a safe and effective alternative to the more traditional means of graft procurement previously used in cases of craniocervical instability in children.