C2 Nerve Root Sectioning in Posterior C1-2 Instrumented Fusions

Does Sacrifice of the C2 Root Benefit C1-2 Arthrodesis?

“…In this review of the literature, one case showed a clear iatrogenic dural leak after sectioning of the nerve root (25). In addition, C2 neurotomies can lead to a 10%-15% risk of hypoesthesia (4,10,16). This rate of hypoesthesias may not be tolerated by all patients equally well.…”

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 47 and 24 patients treated with allograft, respectively (10,30,34,61). The mean estimated blood loss was 159 mL (range: 50 to 500 mL) and the mean duration of operation was 108 minutes.…”

“…Our review supports this reported benefit as we found a trend toward shorter operative times and less blood loss when allograft was used instead of autograft. However, the C2 nerve root was more commonly sacrificed in the allograft patients (67% vs. 23%), a technique that can limit blood loss and surgical duration because of less manipulation of the extensive venous plexus around the nerve and ganglion (34,63). Thus, the increases noted in blood loss and operative times in the autograft group may be partially explained by C2 nerve preservation technique and the harvest of autograft.…”