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--- pediatric_occipitocervical_fusion [2025/07/05 12:34] – [Case series] administrador
+++ pediatric_occipitocervical_fusion [2025/07/05 12:36] (current) – [Retrospective cohort studies] administrador
@@ Line 74: / Line 74: @@
 ===== Retrospective cohort studies =====
+In a [[retrospective cohort study]]
+Shahin et al.
+from the Doernbecher Children's Hospital and Oregon Health & Science University, [[Portland]]
+published in the [[Journal of Neurosurgery Pediatrics]]
+to assess whether [[screw]]‑fixed [[autologous]] rib [[graft]]s improve [[fusion]] rates in pediatric [[occipitocervical fusion]] (OCF), and validate a novel imaging-based fusion grading [[scale]] independent of graft type.
+Screw‑anchored rib autograft achieved 100 % solid fusion at ≥3 months (n=16), compared to 57 % fusion (4/7) and 43 % [[resorption]]/[[pseudarthrosis]] in standard allograft/BMP group (p=0.0066). The new 0–2 radiographic grade correlated well with CT-defined outcomes
+((Shahin MN, Pang BW, Smith JL, Regner MF, Thiessen J, Sayama CM. [[Autologous]] [[rib graft]] [[augmentation]] for [[occipitocervical fusion]] in [[pediatric patient]]s and a novel radiographic grading scale. J Neurosurg Pediatr. 2025 Jul 4:1-13. doi: 10.3171/2025.3.PEDS24530. Epub ahead of print. PMID: 40614282.))
+===== Critical review =====
+. **Study design & cohort:** Retrospective, single‑institution, relatively small sample (n=21 total; final rib‑graft cohort n=17 minus one without CT). Comparison spans two eras (2015–2016 vs. 2016–2022), risks secular trends or surgeon [[learning‑curve bias]].
+. **Intervention vs. control:** Cohort 1 received standard instrumentation with allograft/BMP; cohort 2 received screw‑fixed rib graft. But several cohort 2 cases were revisions from cohort 1, confounding the groups. No randomization.
+. **Outcomes & follow-up:** Fusion assessed at ≥3 months by blinded neuroradiologists with a 0–2 grading scale—clear and reproducible. However, mid / long‑term (>1 year) follow-up beyond early fusion rate not well characterized.
+. **Results interpretation:** Dramatic fusion improvement is compelling, but may reflect both graft technique and instrumentation changes over time. Lack of halo/BMP/lab comparisons limiting.
+. **Radiographic grading scale:** Solid concept, but needs external validation across graft types and institutions.
+. **Safety & complications:** No donor‑site morbidity or hardware failures reported over 5+ years. But small sample limits detection of rare complications.
+. **Limitations:** Small size, retrospective design, era bias, limited demographic detail (syndromic vs. non‑syndromic outcomes), no clinical outcome measures (e.g. neurological, hardware-related pain).
+. **Generalisability:** Promising technique; should be validated via prospective multicentre trials with longer follow‑up and clinical metrics.
+==== Final verdict: 7/10 ====
+==== Takeaway for practicing neurosurgeons: ====
+Pediatric OCF augmented with screw‑fixed rib autograft appears to reliably achieve solid [[arthrodesis]] by 3 months without added donor‑site morbidity. Consideration of this technique is warranted, especially in revision cases or patients at high [[nonunion]] risk. Adopting the novel radiographic grading scale may standardize fusion reporting across centres.
+==== Bottom line: ====
+Screw-anchored rib autograft in pediatric OCF offers markedly improved short‑term fusion rates (100 % vs. 43 %) with minimal morbidity. Yet prospective data and long‑term outcomes are needed before widespread adoption.
+Category: **Pediatric Neurosurgery**, **Spine Surgery**
+Tags: occipitocervical fusion, rib autograft, pediatric, spinal arthrodesis, radiographic grading, fusion rate