{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T22:00:20Z","timestamp":1783807220162,"version":"3.55.0"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The purpose of this study was to identify factors associated with fusion success among pediatric patients undergoing occiput\u2013C2 rigid instrumentation and fusion.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The Pediatric Spine Study Group registry was queried to identify patients \u2264 21 years of age who underwent occiput\u2013C2 posterior spinal rigid instrumentation and fusion and had a 2-year minimum clinical and radiographic (postoperative lateral cervical radiograph or CT scan) follow-up. Fusion failure was defined clinically if a patient underwent hardware revision surgery &gt; 30 days after the index procedure or radiographically by the presence of hardware failure or screw haloing on the most recent follow-up imaging study. Univariate comparisons and multivariable logistic regression analyses were subsequently performed.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Seventy-six patients met inclusion criteria. The median age at surgery was 9 years (range 1.5\u201317.2 years), and 51% of the cohort was male. Overall, 75% of patients had syndromic (n = 41) or congenital (n = 15) etiologies, with the most frequent diagnoses of Down syndrome (28%), Chiari malformation (13%), and Klippel-Feil syndrome (12%). Data were available to determine if there was a fusion failure in 97% (74\/76) of patients. Overall, 38% (28\/74) of patients had fusion failure (95% CI 27%\u201350%). Univariate analysis demonstrated that use of a rigid cervical collar postoperatively (p = 0.04) and structural rib autograft (p = 0.02) were associated with successful fusion. Multivariable logistic regression analysis determined that patients who had rib autograft used in surgery had a 73% decrease in the odds of fusion failure (OR 0.27, 95% CI 0.09\u20130.82; p = 0.02). Age, etiology including Down syndrome, instrumentation type, unilateral instrumentation, use of recombinant human bone morphogenetic protein, and other variables did not influence the risk for fusion failure.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>In this multicenter, multidisciplinary, international registry of children undergoing occiput\u2013C2 instrumentation and fusion, fusion failure was seen in 38% of patients, a higher rate than previously reported in the literature. The authors\u2019 data suggest that postoperative immobilization in a rigid cervical collar may be beneficial, and the use of structural rib autograft should be considered, as rib autograft was associated with a 75% higher chance of successful fusion.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.1.peds23419","type":"journal-article","created":{"date-parts":[[2024,3,23]],"date-time":"2024-03-23T02:25:23Z","timestamp":1711160723000},"page":"583-590","source":"Crossref","is-referenced-by-count":1,"title":["Association between structural rib autograft and the rate of arthrodesis in children undergoing occiput\u2013C2 instrumentation and fusion"],"prefix":"10.3171","volume":"33","author":[{"given":"Alexander","family":"Eremiev","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B.","family":"Kurland","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander T. M.","family":"Cheung","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Cook","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosef","family":"Dastagirzada","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David H.","family":"Harter","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Rodriguez-Olaverri","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, New York University, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Brockmeyer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Primary Children\u2019s Medical Center, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua M.","family":"Pahys","sequence":"additional","affiliation":[{"name":"Departments of Pediatric Orthopedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Hedequist","sequence":"additional","affiliation":[{"name":"Neurosurgery, Boston Children\u2019s Hospital, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Oetgen","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery and Sports Medicine, Children\u2019s National Hospital, Washington, DC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amer F.","family":"Samdani","sequence":"additional","affiliation":[{"name":"Neurosurgery, Shriners Hospital for Children, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard C. E.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"NYU Neurosurgery Network, Ridgewood, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Pediatr Neurosurg","first-page":"81","article-title":"Postoperative immobilization following occipitocervical fusion in the pediatric population: outcome evaluation and review of literature","volume":"53","author":"Pingarilho AR","year":"2018","unstructured":"Pingarilho AR, Porto de Melo PM, Elbabaa SK. Postoperative immobilization following occipitocervical fusion in the pediatric population: outcome evaluation and review of literature. Pediatr Neurosurg. 2018;53(2):81\u201388."},{"issue":"4","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"452","article-title":"Pediatric occipitocervical fixation: radiographic criteria, surgical technique, and clinical outcomes based on experience of a single surgeon","volume":"18","author":"Martinez-Del-Campo E","year":"2016","unstructured":"Martinez-Del-Campo E, Turner JD, Rangel-Castilla L, Soriano-Baron H, Kalb S, Theodore N. Pediatric occipitocervical fixation: radiographic criteria, surgical technique, and clinical outcomes based on experience of a single surgeon. J Neurosurg Pediatr. 2016;18(4):452\u2013462."},{"issue":"20","key":"b3","series-title":"Spine (Phila Pa 1976)","first-page":"2211","article-title":"Comparison between allograft plus demineralized bone matrix versus autograft in anterior cervical fusion. A prospective multicenter study","volume":"20","author":"An HS","year":"1995","unstructured":"An HS, Simpson JM, Glover JM, Stephany J. Comparison between allograft plus demineralized bone matrix versus autograft in anterior cervical fusion. A prospective multicenter study. Spine (Phila Pa 1976). 1995;20(20):2211\u20132216."},{"issue":"1","key":"b4","series-title":"J Neurosurg Pediatr","first-page":"1","article-title":"Spinal instrumentation in infants, children, and adolescents: a review. JNSPG 75th Anniversary Invited Review Article","volume":"23","author":"Mendenhall S","year":"2019","unstructured":"Mendenhall S, Mobasser D, Relyea K, Jea A. Spinal instrumentation in infants, children, and adolescents: a review. JNSPG 75th Anniversary Invited Review Article. 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Pediatr Neurosurg. 2001;34(3):149\u2013155."},{"issue":"2","key":"b21","series-title":"J Neurosurg","first-page":"206","article-title":"Anterior cervical interbody fusion using autogeneic and allogeneic bone graft substrate: a prospective comparative analysis","volume":"85","author":"Bishop RC","year":"1996","unstructured":"Bishop RC, Moore KA, Hadley MN. Anterior cervical interbody fusion using autogeneic and allogeneic bone graft substrate: a prospective comparative analysis. J Neurosurg. 1996;85(2):206\u2013210."},{"issue":"2","key":"b22","series-title":"J Neurosurg Pediatr","first-page":"187","article-title":"Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion: a systematic review of factors affecting fusion rates","volume":"17","author":"Reintjes SL","year":"2016","unstructured":"Reintjes SL, Amankwah EK, Rodriguez LF, Carey CC, Tuite GF. 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