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Author Spotlight: Development and Evaluation of a Standardized Rat Model for Calvarial Suture-Bony Composite Defects
Published on: May 10, 2024
Calvarial bone graft for craniovertebral junction fixation in children
Vitor Nagai Yamaki1,2, Anita Ahmadi Birjandi1, Dominic Thompson3
1Department of Neurosurgery, Great Ormond Street Hospital for Children, Great Ormond St, London, WC1N 3JL, UK.
Insights
Calvarial bone grafting is effective for pediatric craniovertebral fusion, achieving an 80% fusion rate with minimal donor site issues. This method is a viable option when instrumented fixation is not possible.
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.
Purpose:
To evaluate the efficacy of calvarial graft (CG) in craniovertebral fusion procedures in children at a single single center.
Methods:
Paediatric patients in whom CG had been used as the sole construct, or to augment a semi-rigid construct were identified from a prospective operative database. Age, underlying diagnosis and clinical presentation were obtained from review of the electronic patient record. The primary outcome was bony fusion confirmed on CT. Additional outcome measures were donor site morbidity and need for further surgery.
Results:
From 82 paediatric CVJ procedures, CG was used in 15 patients with a mean age of 4.1 (± 3.52) years. Aetiology comprised skeletal dysplasia (n = 12), congenital anomaly of segmentation (n = 1) and cervical trauma (n = 2). Myelopathy was the most common clinical finding (9/15), followed by cervical pain (3/15). The indications for surgery comprised atlanto-axial subluxation (8/15), basilar invagination with compression (2/15), and cervicomedullary compression without instability but deemed at risk of instability following decompression (4/15). CG was used in three scenarios: (i) CG + wire only (n = 10); (ii) CG + semirigid instrumentation (n = 3); (iii) CG to augment rigid instrumented fixation (n = 2). In 13 patients a Halo-body Jacket was used peri-operatively. At a mean time of 4.4 months following surgery, 80% of cases had radiological evidence of fusion.
Conclusion:
Full thickness calvarial bone graft is readily available, has good structural integrity and is associated with minimal donor site morbidity. CG should be considered for use as a sole construct, or to augment semi-rigid constructs when instrumented fixation is precluded.
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