Iliac end-to-end structural autograft for complex failure after occipital cervical fusion: illustrative case.

backgroundOccipital 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. OBSERVATIONS: 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. LESSONS: Bilateral autologous iliac grafts can be combined to overcome a large cervical laminectomy defect during OCF revision surgery. https://thejns.org/doi/10.3171/CASE25649.