====== Rib Graft ======

**Definition:**  
A ''rib graft'' refers to the use of autologous rib bone harvested from the patient to serve as an **osseous graft** in reconstructive or fusion surgeries, particularly in spinal and occipitocervical procedures.

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===== 🩻 Common Indications =====
  * Occipitocervical fusion (OCF) in pediatric and adult patients
  * Atlantoaxial instability
  * Thoracic and lumbar spinal reconstruction
  * Skull base reconstructions
  * Revision surgery where iliac crest is not viable or previously harvested

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===== 🦴 Advantages =====
  * **Autologous**: No risk of immune rejection
  * Readily accessible during the same operative session
  * Often sufficient in length and contour for spinal alignment
  * Avoids donor site morbidity associated with iliac crest

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===== ⚠️ Limitations =====
  * Resorption risk in young children
  * May not provide immediate biomechanical stability
  * Postoperative pain at harvest site
  * Limited quantity compared to iliac crest or fibular grafts

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===== 🧠 Clinical Notes =====
  * Rib grafts can be contoured and shaped to bridge the occiput and cervical spine in OCF.
  * New radiographic grading scales are being developed to assess fusion success with rib grafts, independent of graft type or fixation technique.
  * Often used with posterior instrumentation (e.g., rods and screws).

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===== 🧪 Histological Properties =====
  * Corticocancellous structure
  * Osteoconductive, potentially osteoinductive when fresh
  * Gradual incorporation over weeks to months

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===== 📝 Example Study =====
[[JNS Pediatr 2025]]: *Autologous rib graft augmentation for occipitocervical fusion in pediatric patients and a novel radiographic grading scale*  
Shahin MN et al. demonstrated that rib grafts provide adequate fusion substrate in pediatric OCF when assessed with a technique-independent grading scale.

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**Tags:** rib graft, autograft, occipitocervical fusion, spinal reconstruction, pediatric spine, craniovertebral junction