S-Space College of Medicine/School of Medicine (의과대학/대학원) Orthopedic Surgery (정형외과학전공) Journal Papers (저널논문_정형외과학전공)
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
- Yeom, Jin S.; Riew, K. Daniel; Kang, Sung Shik; Yi, Jemin; Lee, Gun Woo; Yeom, Arim; Chang, Bong-Soon; Lee, Choon-Ki; Kim, Ho-Joong
- Issue Date
- Lippincott, Williams & Wilkins
- Spine, vol.40 no.20, E1093-E1102
- C1–C2 neural foramen; C1–C2 facet joint; occipital neuralgia; C2 root transection; C2 root preservation; decompression; distraction arthrodesis; fusion; C1–C2 segmental screw fixation; intraoperative traction; C1 posterior arch screw; C1 lateral mass screw; surgical technique; C2 root; neural compression
- 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 followup 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 fi xation. The Control group underwent C2 root transection with C1–C2 segmental screw fi xation 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 signifi cant 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 signifi cantly 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 signifi cant difference in improvement in the VAS score for neck pain and neck disability index and Japanese Orthopedic Association recovery rate, which are minimally infl uenced 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.
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