C1 lateral mass screw placement with intentional sacrifice of the C2 ganglion: functional outcomes and morbidity in elderly patients

Abstract

Placement of C1 lateral mass screws may be facilitated by intentional C2 root sacrifice. Functional outcomes and morbidity following intentional sacrifice of the C2 root have not been reported in the literature. The objective is to find out if intentional C2 nerve root sacrifice affects functional outcomes and operative morbidity in patients undergoing posterior cervical fusion with C1 lateral mass screws. The study is a case report. Twenty-two consecutive elderly patients (10 males, 12 females with an average age of 77 years) with C1-2 instability were treated with posterior cervical fusion using C1 lateral mass screw placement. Five patients had preservation of the bilateral C2 nerve roots (PRES group) and 18 patients had intentional sacrifice of the bilateral C2 nerve root (SAC group). Operative times, blood loss, hospital length of stay, and complications were recorded for each patient. Functional outcomes, pain, and satisfaction scores were compared between the two groups at the time of ultimate follow-up. Average follow-up time was 19.3 months (range 6-66). The SAC group demonstrated significantly decreased operative time (109.4 vs. 187 min) and a trend towards decreased blood loss (344 vs. 1,030 mL). At ultimate follow-up both groups experienced similar mild disability with no significant difference in NDI scores, analog pain, and satisfaction scores. No patient had C2 root dysesthesia, swallowing, or speech difficulty. In this small case series, intentional sacrifice of the bilateral C2 nerve root ganglion resulted in less operative time and decreased blood loss in elderly patents undergoing C1-2 posterior fusion with the Harms technique. Functional outcome, pain and satisfaction scores were not adversely affected when this technique was used in elderly patients.

Is Allograft Sufficient for Posterior Atlantoaxial Instrumented Fusions with Screw and Rod Constructs? A Structured Review of Literature

“…The remaining 17 studies were retrospective case series (3,10,15,18,26,28,30,34,38,39,53,61,63,64,67,70,73). All studies provide Class III data.…”

“…Thirteen studies describing 652 patients having C1-2 posterior instrumentation and arthrodesis with polyaxial screw-rod constructs with iliac crest autograft (3,15,18,26,28,38,39,54,63,64,67,70,73) and 7 studies describing 60 patients treated with allograft (10,30,34,53,64,67) serve as the basis of this report. Four patients who had instrumentation without fusion reported in the autograft series were excluded from the fusion outcome analyses (28,38).…”

“…Data concerning estimated blood loss and operative duration were reported in PEER-REVIEW REPORTS (38,39,54,63,73). The mean estimated blood loss was 566 mL (range: 50 to 1800 mL) and the mean duration of operation was 143 minutes.…”

Modified C1 lateral mass screw insertion using a high entry point to avoid postoperative occipital neuralgia

“…16 The suggested that causes of postoperative occipital neuralgia include irritation of the nerve root by the C1 LM screw or traction of the dorsal root ganglion during screw insertion. 2,10,16,17 We believe that the reduction of C1 onto C2 may also contribute to the development of occipital neuralgia.…”

Comparison of perpendicular to the coronal plane versus medial inclination for atlas pedicle screw insertion: an anatomic and radiological study in human cadavers

“…However, controversy over the transverse direction of the C1 pedicle screw has existed for a long time [10][11][12]. Tan et al [10] suggested that the screw trajectory should be perpendicular to the coronal plane, whereas Ma et al [11] recommended medial inclination by about 10°, because complications such as neurovascular injury could arise from the lateral mass screw technique [13,14].…”