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.

• 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

• 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

• 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

• 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).

• Corticocancellous structure
• Osteoconductive, potentially osteoinductive when fresh
• Gradual incorporation over weeks to months

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.

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