C2 Nerve Root Transection During C1 Lateral Mass Screw Fixation: Does It Affect Functionality and Quality of Life?

• Published in: Neurosurgery Vol. 74; no. 5; pp. 475 - 481
• Main Authors: Dewan, Michael C, Godil, Saniya S, Mendenhall, Stephen K, Devin, Clinton J, McGirt, Matthew J
• Format: Journal Article
• Language: English
• Published: United States Copyright by the Congress of Neurological Surgeons 01.05.2014; Wolters Kluwer Health, Inc
• Subjects: Atlanto-Axial Joint - injuries; Atlanto-Axial Joint - surgery; Bone Screws; Cohort Studies; Female; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - instrumentation; Humans; Hypesthesia - etiology; Hypesthesia - physiopathology; Hypesthesia - psychology; Joint Instability - surgery; Male; Middle Aged; Neck Pain - etiology; Neck Pain - physiopathology; Neck Pain - psychology; Neuralgia - etiology; Neuralgia - physiopathology; Neuralgia - psychology; Neurosurgery; Operative Time; Organ Sparing Treatments; Pain Measurement; Patients; Prospective Studies; Quality of Life; Spinal Fusion - adverse effects; Spinal Fusion - instrumentation; Spinal Fusion - methods; Spinal Nerve Roots - injuries; Spinal Nerve Roots - physiopathology; Spinal Nerve Roots - surgery; Surveys and Questionnaires; Treatment Outcome
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/NEU.0000000000000306

BACKGROUND:Sectioning of the C2 nerve root allows for direct visualization of the C1-2 joint and may facilitate arthrodesis. OBJECTIVE:To determine the clinical and functional consequences of C2 nerve root sectioning during placement of C1 lateral mass screws. METHODS:All patients undergoing C1 lateral mass screw fixation were included in this prospective study. A standard questionnaire was used to determine the severity of occipital numbness/pain and its effect on quality of life (QOL). Domains of the neck disability index were used to assess the disability related to C2 symptoms. RESULTS:A total of 28 patients were included (C2 transection, 8; C2 preservation, 20). A trend of decreased blood loss and length of surgery was observed in the C2 transection cohort. Occipital numbness was reported by 4 (50.0%) patients after C2 transection. Occipital neuralgia was reported by 7 (35.0%) patients with C2 preservation. None of the patients with numbness after C2 transection reported being “bothered” by it. All patients with occipital neuralgia after C2 sparing reported being “bothered” by it, and 57.1% reported a moderate to severe effect on QOL. The use of medication was reported by 5 (71.4%) patients with neuralgia vs none with numbness. Mean disability was significantly higher with neuralgia vs numbness (P = .016). CONCLUSION:C2 nerve root transection is associated with increased occipital numbness but this has no effect on patient-reported outcomes and QOL. C2 nerve root preservation can be associated with occipital neuralgia, which has a negative impact on patient disability and QOL. C2 nerve root transection has no negative consequences during C1-2 stabilization. ABBREVIATIONS:NDI, neck disability indexQOL, quality of life