Clinical and radiological Comparison of treatment of atlantoaxial instability by posterior C1–C2 transarticular screw fixation or C1 lateral mass-C2 pedicle screw fixation

Lee, Sun-Ho; Kim, Eun Sang; Sung, Joo-Kyung; Park, Yeun-Mook; Eoh, Whan

doi:10.1016/j.jocn.2009.10.008

Cited by 74 publications

(79 citation statements)

References 28 publications

(49 reference statements)

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“…29 The mean operative time in the present study (129 minutes) is comparable to these prior reports. The mean EBL in prior studies ranged from 123 ml 23 to 730 ml, 21 and the overall range was from 50 ml 35 to 1500 ml. 21,35 The mean EBL in the present study (200 ml) also compares favorably with these prior reports.…”

Section: Discussionmentioning

confidence: 94%

“…The mean EBL in prior studies ranged from 123 ml 23 to 730 ml, 21 and the overall range was from 50 ml 35 to 1500 ml. 21,35 The mean EBL in the present study (200 ml) also compares favorably with these prior reports. Also of note, the maximum EBL in the present study was 350 ml, which contrasts with maximum EBL in other studies in which C-2 neurectomy was not performed (800 ml, 29 1000 ml, 33 1500 ml, 21 and 1500 ml).…”

Section: Discussionmentioning

confidence: 94%

“…Several prior reports document experience with C1-2 segmental instrumented arthrodesis without C-2 neurectomy. 7,18,21,23,30,33,35,38 Among these reports, the mean surgical duration varies considerably, from 83 minutes 35 to 169 minutes, 21 with overall ranges in time from 35 minutes 35 to 240 minutes. 29 The mean operative time in the present study (129 minutes) is comparable to these prior reports.…”

Section: Discussionmentioning

confidence: 99%

“…18 However, popularization and growing experience with the technique of Harms and Melcher has lead to an increasing number of reports documenting new postoperative onset of C-2 neuralgia, likely due to mobilization of the C-2 nerve root and/or direct irritation from the abutting screw. 4,21,23,[29][30][31]33,35 Some of these neuralgias resolve spontaneously, 4,29,31,33,35 some improve with screw removal, 23 and others are intractable. 4,21,30,35 It is not uncommon for symptoms of C-2 neuralgia to accompany atlantoaxial instability, especially among the elderly, due to mechanical compression or injury of the C-2 nerve root.…”

mentioning

confidence: 99%

“…4,21,23,[29][30][31]33,35 Some of these neuralgias resolve spontaneously, 4,29,31,33,35 some improve with screw removal, 23 and others are intractable. 4,21,30,35 It is not uncommon for symptoms of C-2 neuralgia to accompany atlantoaxial instability, especially among the elderly, due to mechanical compression or injury of the C-2 nerve root. 3,8,20,32,34,36 Surgery for occipital pain (C-2 rhizolysis, ganglionectomy, C-1 and C-2 decompression) has been recommended as a treatment option for greater occipital neuralgia after failure of percutaneous nerve blocks and medication.…”

mentioning

confidence: 99%

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C-2 neurectomy during atlantoaxial instrumented fusion in the elderly: patient satisfaction and surgical outcome

Hamilton

Smith

Sansur

et al. 2011

SPI

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Object The originally described technique of atlantoaxial stabilization using C-1 lateral mass and C-2 pars screws includes a C-2 neurectomy to provide adequate hemostasis and visualization for screw placement, enable adequate joint decortication and arthrodesis, and prevent new-onset postoperative C-2 neuralgia. However, inclusion of a C-2 neurectomy for this procedure remains controversial, likely due in part to a lack of studies that have specifically addressed whether it affects patient outcome. The authors' objective was to assess the surgical and clinical impact of routine C-2 neurectomy performed with C1–2 segmental instrumented arthrodesis in a consecutive series of elderly patients with C1–2 instability. Methods Forty-four consecutive patients (mean age 71 years) underwent C1–2 instrumented fusion, including C-1 lateral mass screw insertion. Bilateral C-2 neurectomies were performed. Standardized clinical assessments were performed both pre- and postoperatively. Numbness or discomfort in a C-2 distribution was documented at follow-up. Fusion was assessed using the Lenke fusion grade. Results Among all 44 patients, mean blood loss was 200 ml (range 100–350 ml) and mean operative time was 129 minutes (range 87–240 minutes). There were no intraoperative complications, and no patients reported new postoperative onset or worsening of C-2 neuralgia postoperatively. Outcomes for the 30 patients with a minimum 13-month follow-up (range 13–72 months) were assessed. At a mean follow-up of 36 months, Nurick grade and pain numeric rating scale scores improved from 3.7 to 1.0 (p < 0.001) and 9.4 to 0.6 (p < 0.001), respectively. The mean postoperative Neck Disability Index score was 7.3%. The fusion rate was 97%, and the patient satisfaction rate was 93%. All 24 patients with preoperative occipital neuralgia reported relief. Seventeen patients noticed C-2 distribution numbness only during examination in the clinic, and 2 patients reported C-2 numbness, but it did not affect their daily function. Conclusions In this series of C1–2 instrumented arthrodesis in elderly patients, excellent fusion rates were achieved, and patient satisfaction was not negatively affected by C-2 neurectomy. In the authors' experience, C-2 neurectomy enhanced surgical exposure of the C1–2 joint, thereby facilitating hemostasis, placement of instrumentation, and decortication of the joint space for arthrodesis. Importantly, with C-2 neurectomy in the present series, no cases of new onset postoperative C-2 neuralgia occurred, in contrast to a growing number of reports in the literature documenting new-onset C-2 neuralgia without C-2 neurectomy. On the contrary, 80% of patients in the present series had preoperative occipital neuralgia and in all of these patients this neuralgia was relieved following C1–2 instrumented arthrodesis with C-2 neurectomy.