{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:43Z","timestamp":1776096403655,"version":"3.50.1"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"7","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,2,16]]},"abstract":"\n BACKGROUND<\/jats:title>\n Occipital cervical fusion (OCF) is an effective method for immobilizing the cranial cervical junction (CCJ). OCF failure is uncommon but can be associated with kyphosis after laminectomy. Revision OCF after long-segment cervical laminectomy is challenging, as grafting options are more limited.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The patient was a 53-year-old man with pseudarthrosis, posterior displacement of the occipital plate, a chronic type II odontoid fracture with anterior subluxation of the fractured dens, a fracture of the C1 vertebrae with anterior displacement, and a previous 6- to 7-cm laminectomy defect from C1 to C5. Two iliac autografts, which were harvested from the left and right posterior superior iliac spine, were used. One end of the graft was placed into the occipital notch, and the other was placed over the C5 and C6 lamina. Two cross connectors were then placed over the combined graft, securing it in place. Three loops of fiber wire were tied to each main rod. The loops were then placed below the combined graft to prevent the rod from fracturing into the cervical cord in the event of repeated instrumentation failure.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Bilateral autologous iliac grafts can be combined to overcome a large cervical laminectomy defect during OCF revision surgery.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25649<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25649","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T11:47:16Z","timestamp":1771847236000},"source":"Crossref","is-referenced-by-count":0,"title":["Iliac end-to-end structural autograft for complex failure after occipital cervical fusion: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9017-5343","authenticated-orcid":true,"given":"Parth","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maxmillian","family":"Tjauw","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John F.","family":"Burke","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"J Neurosurg Spine","first-page":"5","article-title":"A systematic review of occipital cervical fusion: techniques and outcomes","volume":"13","author":"Winegar","year":"2010","unstructured":"Winegar CDLawrence JPFriel BCA systematic review of occipital cervical fusion: techniques and outcomes. J Neurosurg Spine. 2010;13(1):5-16."},{"issue":"5","key":"bib2","series-title":"Neurosurgery","first-page":"1396","article-title":"A review of complications associated with craniocervical fusion surgery","volume":"67","author":"Lall","year":"2010","unstructured":"Lall RPatel NJResnick DK.A review of complications associated with craniocervical fusion surgery. Neurosurgery. 2010;67(5):1396-1403."},{"issue":"4","key":"bib3","series-title":"Neurosurgery","first-page":"549","article-title":"Occipitocervical fixation: a single surgeon\u2019s experience with 120 patients","volume":"79","author":"Martinez-Del-Campo","year":"2016","unstructured":"Martinez-Del-Campo ETurner JDKalb SOccipitocervical fixation: a single surgeon\u2019s experience with 120 patients. Neurosurgery. 2016;79(4):549-560."},{"issue":"5","key":"bib4","series-title":"Spine (Phila Pa 1976)","first-page":"530","article-title":"Occipitocervical fixation: long-term results","volume":"30","author":"Deutsch","year":"2005","unstructured":"Deutsch HHaid RWRodts GEMummaneni PV.Occipitocervical fixation: long-term results. Spine (Phila Pa 1976). 2005;30(5):530-535."},{"issue":"5","key":"bib5","series-title":"J Neurol Surg B Skull Base","first-page":"331","article-title":"Occipitocervical fusion surgery: review of operative techniques and results","volume":"76","author":"Kukreja","year":"2015","unstructured":"Kukreja SAmbekar SSin AHNanda A.Occipitocervical fusion surgery: review of operative techniques and results. J Neurol Surg B Skull Base. 2015;76(5):331-339."},{"issue":"2","key":"bib6","series-title":"J Neurosurg Spine","first-page":"117","article-title":"Occipitocervical fusion with rigid internal fixation: long-term follow-up data in 69 patients","volume":"7","author":"Nockels","year":"2007","unstructured":"Nockels RPShaffrey CIKanter ASAzeem SYork JE.Occipitocervical fusion with rigid internal fixation: long-term follow-up data in 69 patients. J Neurosurg Spine. 2007;7(2):117-123."},{"issue":"3","key":"bib7","series-title":"Spine J","first-page":"206","article-title":"Bone grafting alternatives in spinal surgery","volume":"2","author":"Vaccaro","year":"2002","unstructured":"Vaccaro ARChiba KHeller JGBone grafting alternatives in spinal surgery. Spine J. 2002;2(3):206-215."},{"issue":"2","key":"bib8","series-title":"J Neurosurg Spine","first-page":"144","article-title":"Comparison of structural allograft and traditional autograft technique in occipitocervical fusion: radiological and clinical outcomes from a single institution","volume":"23","author":"Godzik","year":"2015","unstructured":"Godzik JRavindra VMRay WZSchmidt MHBisson EFDailey AT.Comparison of structural allograft and traditional autograft technique in occipitocervical fusion: radiological and clinical outcomes from a single institution. J Neurosurg Spine. 2015;23(2):144-152."},{"issue":"4","key":"bib9","series-title":"J Neurosurg Spine","first-page":"333","article-title":"Rigid occipitocervical fixation: indications, outcomes, and complications in the modern era","volume":"18","author":"Bhatia","year":"2013","unstructured":"Bhatia RDesouza RMBull JCasey ATH.Rigid occipitocervical fixation: indications, outcomes, and complications in the modern era. J Neurosurg Spine. 2013;18(4):333-339."},{"issue":"2","key":"bib10","series-title":"Eur Spine J","first-page":"311","article-title":"Complications of occipitocervical fixation: retrospective review of 128 patients with 5-year mean follow-up","volume":"31","author":"Zileli","year":"2022","unstructured":"Zileli MAk\u0131nt\u00fcrk N.Complications of occipitocervical fixation: retrospective review of 128 patients with 5-year mean follow-up. Eur Spine J. 2022;31(2):311-326."},{"issue":"8","key":"bib11","series-title":"Eur Spine J","first-page":"1720","article-title":"The causes and treatment strategies for the postoperative complications of occipitocervical fusion: a 316 cases retrospective analysis","volume":"23","author":"He","year":"2014","unstructured":"He BYan LXu ZChang ZHao D.The causes and treatment strategies for the postoperative complications of occipitocervical fusion: a 316 cases retrospective analysis. Eur Spine J. 2014;23(8):1720-1724."},{"issue":"6","key":"bib12","series-title":"Spine J","first-page":"911","article-title":"Uncorrected sagittal plane imbalance predisposes to symptomatic instrumentation failure","volume":"8","author":"Gilad","year":"2008","unstructured":"Gilad RGandhi CDArginteanu MSMoore FMSteinberger ACamins M.Uncorrected sagittal plane imbalance predisposes to symptomatic instrumentation failure. Spine J. 2008;8(6):911-917."},{"key":"bib13","series-title":"N Am Spine Soc J","first-page":"100017","article-title":"Postoperative complication rates and hazards-model survival analysis of revision surgery following occipitocervical and atlanto-axial fusion","volume":"3","author":"Yang","year":"2020","unstructured":"Yang DSPatel SADiSilvestro KJLi NYDaniels AH.Postoperative complication rates and hazards-model survival analysis of revision surgery following occipitocervical and atlanto-axial fusion. N Am Spine Soc J. 2020;3:100017."},{"issue":"suppl 1","key":"bib14","series-title":"Eur Spine J","first-page":"243","article-title":"Temporary fusionless posterior occipitocervical fixation for a proximal junctional type II odontoid fracture after previous C2-pelvis fusion: case report, description of a new surgical technique, and review of the literature","volume":"26","author":"Theologis","year":"2017","unstructured":"Theologis AADeviren VTay B.Temporary fusionless posterior occipitocervical fixation for a proximal junctional type II odontoid fracture after previous C2-pelvis fusion: case report, description of a new surgical technique, and review of the literature. Eur Spine J. 2017;26(suppl 1):243-248."},{"issue":"3","key":"bib15","series-title":"Musculoskelet Surg","first-page":"171","article-title":"Autologous bone graft harvesting: a review of grafts and surgical techniques","volume":"99","author":"Jakoi","year":"2015","unstructured":"Jakoi AMIorio JACahill PJ.Autologous bone graft harvesting: a review of grafts and surgical techniques. Musculoskelet Surg. 2015;99(3):171-178."},{"issue":"2","key":"bib16","series-title":"J Neurosurg","first-page":"255","article-title":"A comparative analysis of fusion rates and donor-site morbidity for autogeneic rib and iliac crest bone grafts in posterior cervical fusions","volume":"88","author":"Sawin","year":"1998","unstructured":"Sawin PDTraynelis VCMenezes AH.A comparative analysis of fusion rates and donor-site morbidity for autogeneic rib and iliac crest bone grafts in posterior cervical fusions. J Neurosurg. 1998;88(2):255-265."},{"issue":"40","key":"bib17","series-title":"Med (Baltim)","article-title":"Long-term follow-up of fibular graft for the reconstruction of bone defects","volume":"97","author":"Liu","year":"2018","unstructured":"Liu STao STan JHu XLiu HLi Z.Long-term follow-up of fibular graft for the reconstruction of bone defects. Med (Baltim). 2018;97(40):e12605."},{"issue":"11","key":"bib18","series-title":"Spine J","first-page":"893","article-title":"Donor-site complications of autogenous nonvascularized fibula strut graft harvest for anterior cervical corpectomy and fusion surgery: experience with 163 consecutive cases","volume":"9","author":"Nassr","year":"2009","unstructured":"Nassr AKhan MHAli MHDonor-site complications of autogenous nonvascularized fibula strut graft harvest for anterior cervical corpectomy and fusion surgery: experience with 163 consecutive cases. Spine J. 2009;9(11):893-898."},{"issue":"394","key":"bib19","series-title":"Clin Orthop Relat Res","first-page":"47","article-title":"The use of titanium mesh cages in the cervical spine","author":"Riew","year":"2002","unstructured":"Riew KDRhee JM.The use of titanium mesh cages in the cervical spine. Clin Orthop Relat Res. 2002;(394):47-54."},{"issue":"7","key":"bib20","series-title":"Spine (Phila Pa 1976)","first-page":"825","article-title":"A technique of occipitocervical arthrodesis in children using autologous rib grafts","volume":"26","author":"Cohen","year":"2001","unstructured":"Cohen MWDrummond DSFlynn JMPill SGDormans JP.A technique of occipitocervical arthrodesis in children using autologous rib grafts. Spine (Phila Pa 1976). 2001;26(7):825-829."},{"issue":"1","key":"bib1","series-title":"J Neurosurg Spine","first-page":"5","article-title":"A systematic review of occipital cervical fusion: techniques and outcomes","volume":"13","author":"Winegar","year":"2010","unstructured":"Winegar CDLawrence JPFriel BCA systematic review of occipital cervical fusion: techniques and outcomes. J Neurosurg Spine. 2010;13(1):5-16."},{"issue":"5","key":"bib2","series-title":"Neurosurgery","first-page":"1396","article-title":"A review of complications associated with craniocervical fusion surgery","volume":"67","author":"Lall","year":"2010","unstructured":"Lall RPatel NJResnick DK.A review of complications associated with craniocervical fusion surgery. Neurosurgery. 2010;67(5):1396-1403."},{"issue":"4","key":"bib3","series-title":"Neurosurgery","first-page":"549","article-title":"Occipitocervical fixation: a single surgeon\u2019s experience with 120 patients","volume":"79","author":"Martinez-Del-Campo","year":"2016","unstructured":"Martinez-Del-Campo ETurner JDKalb SOccipitocervical fixation: a single surgeon\u2019s experience with 120 patients. Neurosurgery. 2016;79(4):549-560."},{"issue":"5","key":"bib4","series-title":"Spine (Phila Pa 1976)","first-page":"530","article-title":"Occipitocervical fixation: long-term results","volume":"30","author":"Deutsch","year":"2005","unstructured":"Deutsch HHaid RWRodts GEMummaneni PV.Occipitocervical fixation: long-term results. Spine (Phila Pa 1976). 2005;30(5):530-535."},{"issue":"5","key":"bib5","series-title":"J Neurol Surg B Skull Base","first-page":"331","article-title":"Occipitocervical fusion surgery: review of operative techniques and results","volume":"76","author":"Kukreja","year":"2015","unstructured":"Kukreja SAmbekar SSin AHNanda A.Occipitocervical fusion surgery: review of operative techniques and results. J Neurol Surg B Skull Base. 2015;76(5):331-339."},{"issue":"2","key":"bib6","series-title":"J Neurosurg Spine","first-page":"117","article-title":"Occipitocervical fusion with rigid internal fixation: long-term follow-up data in 69 patients","volume":"7","author":"Nockels","year":"2007","unstructured":"Nockels RPShaffrey CIKanter ASAzeem SYork JE.Occipitocervical fusion with rigid internal fixation: long-term follow-up data in 69 patients. J Neurosurg Spine. 2007;7(2):117-123."},{"issue":"3","key":"bib7","series-title":"Spine J","first-page":"206","article-title":"Bone grafting alternatives in spinal surgery","volume":"2","author":"Vaccaro","year":"2002","unstructured":"Vaccaro ARChiba KHeller JGBone grafting alternatives in spinal surgery. Spine J. 2002;2(3):206-215."},{"issue":"2","key":"bib8","series-title":"J Neurosurg Spine","first-page":"144","article-title":"Comparison of structural allograft and traditional autograft technique in occipitocervical fusion: radiological and clinical outcomes from a single institution","volume":"23","author":"Godzik","year":"2015","unstructured":"Godzik JRavindra VMRay WZSchmidt MHBisson EFDailey AT.Comparison of structural allograft and traditional autograft technique in occipitocervical fusion: radiological and clinical outcomes from a single institution. J Neurosurg Spine. 2015;23(2):144-152."},{"issue":"4","key":"bib9","series-title":"J Neurosurg Spine","first-page":"333","article-title":"Rigid occipitocervical fixation: indications, outcomes, and complications in the modern era","volume":"18","author":"Bhatia","year":"2013","unstructured":"Bhatia RDesouza RMBull JCasey ATH.Rigid occipitocervical fixation: indications, outcomes, and complications in the modern era. J Neurosurg Spine. 2013;18(4):333-339."},{"issue":"2","key":"bib10","series-title":"Eur Spine J","first-page":"311","article-title":"Complications of occipitocervical fixation: retrospective review of 128 patients with 5-year mean follow-up","volume":"31","author":"Zileli","year":"2022","unstructured":"Zileli MAk\u0131nt\u00fcrk N.Complications of occipitocervical fixation: retrospective review of 128 patients with 5-year mean follow-up. Eur Spine J. 2022;31(2):311-326."},{"issue":"8","key":"bib11","series-title":"Eur Spine J","first-page":"1720","article-title":"The causes and treatment strategies for the postoperative complications of occipitocervical fusion: a 316 cases retrospective analysis","volume":"23","author":"He","year":"2014","unstructured":"He BYan LXu ZChang ZHao D.The causes and treatment strategies for the postoperative complications of occipitocervical fusion: a 316 cases retrospective analysis. Eur Spine J. 2014;23(8):1720-1724."},{"issue":"6","key":"bib12","series-title":"Spine J","first-page":"911","article-title":"Uncorrected sagittal plane imbalance predisposes to symptomatic instrumentation failure","volume":"8","author":"Gilad","year":"2008","unstructured":"Gilad RGandhi CDArginteanu MSMoore FMSteinberger ACamins M.Uncorrected sagittal plane imbalance predisposes to symptomatic instrumentation failure. Spine J. 2008;8(6):911-917."},{"key":"bib13","series-title":"N Am Spine Soc J","first-page":"100017","article-title":"Postoperative complication rates and hazards-model survival analysis of revision surgery following occipitocervical and atlanto-axial fusion","volume":"3","author":"Yang","year":"2020","unstructured":"Yang DSPatel SADiSilvestro KJLi NYDaniels AH.Postoperative complication rates and hazards-model survival analysis of revision surgery following occipitocervical and atlanto-axial fusion. N Am Spine Soc J. 2020;3:100017."},{"issue":"suppl 1","key":"bib14","series-title":"Eur Spine J","first-page":"243","article-title":"Temporary fusionless posterior occipitocervical fixation for a proximal junctional type II odontoid fracture after previous C2-pelvis fusion: case report, description of a new surgical technique, and review of the literature","volume":"26","author":"Theologis","year":"2017","unstructured":"Theologis AADeviren VTay B.Temporary fusionless posterior occipitocervical fixation for a proximal junctional type II odontoid fracture after previous C2-pelvis fusion: case report, description of a new surgical technique, and review of the literature. Eur Spine J. 2017;26(suppl 1):243-248."},{"issue":"3","key":"bib15","series-title":"Musculoskelet Surg","first-page":"171","article-title":"Autologous bone graft harvesting: a review of grafts and surgical techniques","volume":"99","author":"Jakoi","year":"2015","unstructured":"Jakoi AMIorio JACahill PJ.Autologous bone graft harvesting: a review of grafts and surgical techniques. Musculoskelet Surg. 2015;99(3):171-178."},{"issue":"2","key":"bib16","series-title":"J Neurosurg","first-page":"255","article-title":"A comparative analysis of fusion rates and donor-site morbidity for autogeneic rib and iliac crest bone grafts in posterior cervical fusions","volume":"88","author":"Sawin","year":"1998","unstructured":"Sawin PDTraynelis VCMenezes AH.A comparative analysis of fusion rates and donor-site morbidity for autogeneic rib and iliac crest bone grafts in posterior cervical fusions. J Neurosurg. 1998;88(2):255-265."},{"issue":"40","key":"bib17","series-title":"Med (Baltim)","article-title":"Long-term follow-up of fibular graft for the reconstruction of bone defects","volume":"97","author":"Liu","year":"2018","unstructured":"Liu STao STan JHu XLiu HLi Z.Long-term follow-up of fibular graft for the reconstruction of bone defects. Med (Baltim). 2018;97(40):e12605."},{"issue":"11","key":"bib18","series-title":"Spine J","first-page":"893","article-title":"Donor-site complications of autogenous nonvascularized fibula strut graft harvest for anterior cervical corpectomy and fusion surgery: experience with 163 consecutive cases","volume":"9","author":"Nassr","year":"2009","unstructured":"Nassr AKhan MHAli MHDonor-site complications of autogenous nonvascularized fibula strut graft harvest for anterior cervical corpectomy and fusion surgery: experience with 163 consecutive cases. Spine J. 2009;9(11):893-898."},{"issue":"394","key":"bib19","series-title":"Clin Orthop Relat Res","first-page":"47","article-title":"The use of titanium mesh cages in the cervical spine","author":"Riew","year":"2002","unstructured":"Riew KDRhee JM.The use of titanium mesh cages in the cervical spine. Clin Orthop Relat Res. 2002;(394):47-54."},{"issue":"7","key":"bib20","series-title":"Spine (Phila Pa 1976)","first-page":"825","article-title":"A technique of occipitocervical arthrodesis in children using autologous rib grafts","volume":"26","author":"Cohen","year":"2001","unstructured":"Cohen MWDrummond DSFlynn JMPill SGDormans JP.A technique of occipitocervical arthrodesis in children using autologous rib grafts. 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