Background Occipitocervical and atlantoaxial instability in the pediatric population is a rare and challenging condition to treat. Variable surgical techniques have been employed to achieve fusion.... Show moreBackground Occipitocervical and atlantoaxial instability in the pediatric population is a rare and challenging condition to treat. Variable surgical techniques have been employed to achieve fusion. The study aimed to assess bony fusion with rigid craniocervical fixation using an allograft bone block to serve as scaffold for bony fusion. Methods This is a single center case series from a tertiary referral neurosurgical center. The series includes 12 consecutive pediatric patients with rigid craniocervical fusion between 2006 and 2014. The primary outcome was bony fusion as assessed by computed tomography and flexion-extension radiographs. The authors did not receive external funding for this study. Results Twelve patients (age 1-15 years) were operated with a median imaging follow-up time of 22 months (range 6-69 m). A modified Gallie fusion technique with a tightly wired allograft bone block was used in 10 of 13 procedures. One patient underwent re-fixation due to screw breakage. Eleven out of 13 procedures resulted in a stable construct with bony fusion. All 10 patients operated with the modified Gallie fusion technique with sublaminar wiring of allograft bone block had bony fusion. No post-operative complications of the posterior fixation procedure were noted. Conclusions The modified Gallie fusion technique with allograft bone block without post-operative immobilization achieved excellent fusion. We conclude there is no need to use autograft or BMPs in craniocervical fusion in the pediatric population, which avoids related donor-site morbidity. Show less
Reconstructions for tumor resections in the pelvis and appendicular skeleton are among the most challenging procedures in modern orthopaedics. Limb salvage surgery is currently the treatment of... Show moreReconstructions for tumor resections in the pelvis and appendicular skeleton are among the most challenging procedures in modern orthopaedics. Limb salvage surgery is currently the treatment of choice for over 90% of patients with a primary malignant bone tumor. This thesis aims to evaluate the outcomes of various reconstructive techniques, and to identify risk factors for complications or impaired outcome following reconstruction. Part I focuses on the management of pelvic bone tumors; it discusses the management and outcome of conventional primary central chondrosarcoma of the pelvis, and two techniques for periacetabular reconstruction. Part II focuses on different types of allograft reconstructions, as well as reconstructions with modular endoprostheses, for tumors of the extremities. Show less
