Journal
SPINE
Volume 40, Issue 20, Pages E1093-E1102Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/BRS.0000000000001031
Keywords
C1-C2 neural foramen; C1-C2 facet joint; occipital neuralgia; C2 root transection; C2 root preservation; decompression; distraction arthrodesis; fusion; C1-C2 segmental screw fixation; intraoperative traction; C1 posterior arch screw; C1 lateral mass screw; surgical technique; C2 root; neural compression
Categories
Funding
- Seoul National University Bundang Hospital grant funds [02-2015-034]
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Study Design. Prospective observational cohort study. Objective. To compare the outcomes of our new technique, distraction arthrodesis of C1-C2 facet joint with C2 root preservation (Study group), to those of conventional C1-C2 fusion with C2 root transection (Control group) for the management of intractable occipital neuralgia caused by C2 root compression. Summary of Background Data. We are not aware of any report concerning C2 root decompression during C1-C2 fusion. Materials and Methods. Inclusion criteria were visual analogue scale (VAS) score for occipital neuralgia 7 or more; C2 root compression at the collapsed C1-C2 neural foramen; and follow-up 12 months or more. The Study group underwent surgery with our new technique including (1) C1-C2 facet joint distraction and bone block insertion while preserving the C2 root; and (2) use of C1 posterior arch screws instead of conventional lateral mass screws during C1-C2 segmental screw fixation. The Control group underwent C2 root transection with C1-C2 segmental screw fixation and fusion. We compared the prospectively collected outcomes data. Results. There were 15 patients in the Study group and 8 in the Control group. Although there was no significant difference in the VAS score for the occipital neuralgia between the 2 groups preoperatively (8.2 +/- 0.9 vs. 7.9 +/- 0.6, P = 0.39), it was significantly lower in the Study group at 1, 3, and 6 months postoperatively (P < 0.01, respectively). At 12 months, it was 0.4 +/- 0.6 versus 2.5 +/- 2.6 (P = 0.01). There was no significant difference in improvement in the VAS score for neck pain and neck disability index and Japanese Orthopedic Association recovery rate, which are minimally influenced by occipital neuralgia. Conclusion. Our novel technique of distraction arthrodesis with C2 root preservation can be an effective option for the management of intractable occipital neuralgia caused by C2 root compression.
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