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Distraction Arthrodesis of the C1-C2 Facet Joint with Preservation of the C2 Root for the Management of Intractable Occipital Neuralgia Caused by C2 Root Compression.

Abstract：

STUDY DESIGN:Prospective observational cohort study. OBJECTIVE:To compare the outcomes of our new technique, distraction arthrodesis of C1-C2 facet joint with C2 root preservation (Study group), to those of conventional C1-C2 fusion with C2 root transection (Control group) for the management of intractable occipital neuralgia caused by C2 root compression. SUMMARY OF BACKGROUND DATA:We are not aware of any report concerning C2 root decompression during C1-C2 fusion. MATERIALS AND METHODS:Inclusion criteria were visual analogue scale (VAS) score for occipital neuralgia 7 or more; C2 root compression at the collapsed C1-C2 neural foramen; and follow-up 12 months or more. The Study group underwent surgery with our new technique including (1) C1-C2 facet joint distraction and bone block insertion while preserving the C2 root; and (2) use of C1 posterior arch screws instead of conventional lateral mass screws during C1-C2 segmental screw fixation. The Control group underwent C2 root transection with C1-C2 segmental screw fixation and fusion. We compared the prospectively collected outcomes data. RESULTS:There were 15 patients in the Study group and 8 in the Control group. Although there was no significant difference in the VAS score for the occipital neuralgia between the 2 groups preoperatively (8.2 ± 0.9 vs. 7.9 ± 0.6, P = 0.39), it was significantly lower in the Study group at 1, 3, and 6 months postoperatively (P < 0.01, respectively). At 12 months, it was 0.4 ± 0.6 versus 2.5 ± 2.6 (P = 0.01). There was no significant difference in improvement in the VAS score for neck pain and neck disability index and Japanese Orthopedic Association recovery rate, which are minimally influenced by occipital neuralgia. CONCLUSION:Our novel technique of distraction arthrodesis with C2 root preservation can be an effective option for the management of intractable occipital neuralgia caused by C2 root compression.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Yeom JS,Riew KD,Kang SS,Yi J,Lee GW,Yeom A,Chang BS,Lee CK,Kim HJ

doi

10.1097/BRS.0000000000001031

subject

Has Abstract

pub_date

2015-10-15 00:00:00

pages

E1093-102

issue

eissn

0362-2436

issn

1528-1159

pii

00007632-201510150-00008

journal_volume

pub_type

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Distraction Arthrodesis of the C1-C2 Facet Joint with Preservation of the C2 Root for the Management of Intractable Occipital Neuralgia Caused by C2 Root Compression.