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Craniovertebral fusion in an infant using struts of banked adult bone
Giuseppe Talamonti1, Giuseppe D'Aliberti2, Alberto Debernardi2
1Department of Neurosurgery, Niguarda Ca'Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy. tala_nch@yahoo.it.
Insights
Craniocervical fusion in infants is challenging. Using cadaveric fibula struts for occipitocervical fusion in an infant with complex malformation led to successful fusion and recovery.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Craniovertebral Junction Abnormalities
Background:
- Craniocervical instability and fusion present unique challenges in infants.
- While craniovertebral joint malformations are relatively common, true instability is rare in this age group.
Observation:
- An 8-month-old infant with tetraparesis and sleep apnea due to a complex craniovertebral junction malformation underwent surgical management.
- Initial treatment with autologous rib grafts failed due to graft reabsorption, leading to recurrent clinical deficits.
Findings:
- Reoperation using banked cadaveric adult fibula struts for occipitocervical interposition achieved adequate fusion.
- The patient's skull maturity allowed for halo system immobilization, resulting in full clinical recovery.
Implications:
- Cadaveric bone struts offer a viable alternative for infant craniovertebral fusion when screw fixation is not feasible.
- Meticulous surgical technique, graft compression, and robust postoperative immobilization are crucial for successful outcomes in pediatric craniovertebral fusion.
Purpose:
The aim of this paper is to discuss the problems of craniocervical instability and craniocervical fusion in infancy. Despite the relative frequency of carniovertebral joint malformations, actual instability is quite rare in infancy.
Methods:
An infant 8 months of age presented with tetraparesis and sleep apnea due to a complex malformation of her craniovertebral joint. An initial attempt at conservative treatment using a rigid neck collar failed, so the patient was surgically managed by the onlay placement of two autologous rib grafts. The rigid collar was maintained for 5 months.
Results:
Both rib grafts progressively reabsorbed within a few months, while the clinical deficits recurred. Reoperation consisted of occipitocervical interposition of two robust struts of banked cadaveric adult fibula. This time, the skull appeared mature enough to allow immobilization by the halo system. Adequate occipitocervical fusion was eventually achieved, and the patient fully recovered.
Conclusions:
To the best of our knowledge, there is no other reported case of an infant undergoing craniovertebral fusion using cadaveric adult bone. When screw placement is not considered advisable to manage small infants, appropriate stability may be obtained using struts of robust cadaveric bone. A meticulous carpentry technique with graft interposition under compression and adequate postoperative immobilization remains mandatory.
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