Entrapment of the C2 Root and Ganglion by the Atlanto-Epistrophic Ligament: Clinical Syndrome and Surgical Anatomy

Poletti, Charles E.; Sweet, William H.

doi:10.1227/00006123-199008000-00019

Cited by 66 publications

(42 citation statements)

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“…Monu et al [26]. Berthelot et al [27] et Poletti et Sweet [28] ou des neuro-radio logues comme Haughton [29| reprennent la classique notion de membrane atlanto-occipitale postérieure sans remise en cause d'aucune des structures décrites dans les grands traités d'anatomie.…”

Section: Discussionunclassified

Les espaces intervertébraux postérieurs de la jointure crânio-rachidienne

Kahn¹,

Sick²,

Koritké³

1992

Cells Tissues Organs

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Closing of the posterior intervertebral spaces of the craniovertebral joint is not performed by the classical posterior atlantooccipital and atlantoaxial membranes. In the atlantooccipital space, the connective laminae come from the occipital periosteum and from the anterior fascia of the rectus capitis posterior minor muscle, and pass round the anterior side of the posterior arch of the atlas to reach the spinal dura mater. In the atlantoaxial space, the anterior fasciae of the rectus capitis posterior major muscle and of the inferior oblique muscle, as well as the periosteum of the posterior arch of the atlas, extend to reach the spinal dura mater. Thus, the epidural space is ceiled posteriorly by the connective laminae of the atlantoaxial space, and lets above a superior recessus containing the ganglia of the spinal nerves Cl and C2 and in which the vertebral artery transits.

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Section: Discussionunclassified

Les espaces intervertébraux postérieurs de la jointure crânio-rachidienne

Kahn¹,

Sick²,

Koritké³

1992

Cells Tissues Organs

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“…In these cases a wide variety of treatments have been advocated, including cervical collar, massage, heat, traction, anesthetic or steroid injections, and distal nerve sectioning. Recently, Poletti et al [76,77] have proposed another mechanism, that being entrapment of the second or third cervical root and dorsal root ganglion either by ligamentous or fascial structures in their respective neural foramina, or by osteoarthritis and spondylosis. Surgical exploration of the C2 or C3 foramen may demonstrate neural compression, which when relieved, may result in pain remission without the necessity for a neuroablative procedure.…”

Section: Occipital Neuralgiamentioning

confidence: 99%

Trigeminal neuralgia and other neuropathic pain syndromes of the head and face

Elias

Burchiel

2002

Current Science Inc

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Trigeminal neuralgia is the most common craniofacial pain syndrome of neuropathic origin. Although the diagnosis remains based exclusively on history and symptomatology, modern diagnostic techniques, particularly high-resolution magnetic resonance imaging, provides valuable new insight into the pathophysiology of these cases with additional implications for therapeutic strategies. Other neuropathic syndromes affect the trigeminal nerve and warrant different treatments with varied rates of success. Rarely, neuralgias of other cranial nerves mimic trigeminal neuralgia. Finally, it is imperative to distinguish atypical facial pains from these neuropathic syndromes to avoid unsuccessful therapies.

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“…4,12 Imaging-positive impingement of nerve rootlets by C1-2 facet joint hypertrophy, fenestrated vertebral artery, 24 or the atlantoepistrophic ligament 30 may be amenable to surgical decompression. In the context of ON, successful decompressions by Poletti (C2-3 nerve roots) and Morikawa et al (C1-2 nerve roots) underscore the utility of decompressive surgery in certain circumstances 24,31 and the need to properly image patients to rule out these disorders. Peripheral nerve stimulation of the occipital nerve may also be a viable solution for refractory ON.…”

Section: Alternatives To Dorsal Root Rhizotomymentioning

confidence: 99%

Long-term outcomes of intradural cervical dorsal root rhizotomy for refractory occipital neuralgia

Gande

Chivukula

Moossy³

et al. 2016

JNS

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OBJECT Occipital neuralgia (ON) causes chronic pain in the cutaneous distribution of the greater and lesser occipital nerves. The long-term efficacy of cervical dorsal root rhizotomy (CDR) in the management of ON has not been well described. The authors reviewed their 14-year experience with CDR to assess pain relief and functional outcomes in patients with medically refractory ON. METHODS A retrospective chart review of 75 ON patients who underwent cervical dorsal root rhizotomy, from 1998 to 2012, was performed. Fifty-five patients were included because they met the International Headache Society's (IHS) diagnostic criteria for ON, responded to CT-guided nerve blocks at the C-2 dorsal nerve root, and had at least one follow-up visit. Telephone interviews were additionally used to obtain data on patient satisfaction. RESULTS Forty-two patients (76%) were female, and the average age at surgery was 46 years (range 16–80). Average follow up was 67 months (range 5–150). Etiologies of ON included the following: idiopathic (44%), posttraumatic (27%), postsurgical (22%), post–cerebrovascular accident (4%), postherpetic (2%), and postviral (2%). At last follow-up, 35 patients (64%) reported full pain relief, 11 (20%) partial relief, and 7 (16%) no pain relief. The extent of pain relief after CDR was not significantly associated with ON etiology (p = 0.43). Of 37 patients whose satisfaction-related data were obtained, 25 (68%) reported willingness to undergo repeat surgery for similar pain relief, while 11 (30%) reported no such willingness; a single patient (2%) did not answer this question. Twenty-one individuals (57%) reported that their activity level/functional state improved after surgery, 5 (13%) reported a decline, and 11 (30%) reported no difference. The most common acute postoperative complications were infections in 9% (n = 5) and CSF leaks in 5% (n = 3); chronic complications included neck pain/stiffness in 16% (n = 9) and upper-extremity symptoms in 5% (n = 3) such as trapezius weakness, shoulder pain, and arm paresthesias. CONCLUSIONS Cervical dorsal root rhizotomy provides an efficacious means for pain relief in patients with medically refractory ON. In the appropriately selected patient, it may lead to optimal outcomes with a relatively low risk of complications.

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Entrapment of the C2 Root and Ganglion by the Atlanto-Epistrophic Ligament: Clinical Syndrome and Surgical Anatomy

Cited by 66 publications

References 0 publications

Les espaces intervertébraux postérieurs de la jointure crânio-rachidienne

Les espaces intervertébraux postérieurs de la jointure crânio-rachidienne

Trigeminal neuralgia and other neuropathic pain syndromes of the head and face

Long-term outcomes of intradural cervical dorsal root rhizotomy for refractory occipital neuralgia

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