Calvarial bone graft for craniovertebral junction fixation in children

Area of Science:

• Orthopedic Surgery
• Pediatric Neurosurgery
• Spinal Fusion Techniques

Background:

• Craniovertebral junction (CVJ) instability in children requires effective fusion methods.
• Calvarial graft (CG) offers a potential solution for complex pediatric spinal fusions.

Purpose of the Study:

• To assess the efficacy of calvarial graft (CG) in pediatric craniovertebral fusion procedures.
• Evaluate CG as a sole construct or augmentation for semi-rigid constructs.

Main Methods:

• Prospective review of pediatric patients undergoing CVJ fusion with CG.
• Data collected included age, diagnosis, clinical presentation, and surgical technique.
• Primary outcome: bony fusion on CT; secondary outcomes: donor site morbidity, re-operation rates.

Main Results:

• 15 pediatric patients (mean age 4.1 years) with skeletal dysplasia, congenital anomalies, or trauma underwent CVJ fusion using CG.
• Common indications included atlanto-axial subluxation and cervicomedullary compression.
• 80% fusion rate achieved at a mean of 4.4 months post-surgery, with minimal donor site morbidity.

Conclusions:

• Calvarial bone graft is a readily available and structurally sound option for pediatric CVJ fusion.
• CG demonstrates good efficacy as a sole construct or adjunct to semi-rigid constructs.
• It is particularly useful when instrumented fixation is contraindicated.