Cervico-occipital pain and its surgical treatment: the myth of the bony millstones.
The proposal was made in 1949 that occipital neuritis/neuralgia was frequently of traumatic origin. The hypothesis was advanced that the C2 sensory root lay unprotected between the lateral masses of the atlas and axis and was vulnerable to squeezing on extreme extension or rotation of the head. This conjecture converted a hitherto banal neurologic affliction into the sequela of a banal trauma. Hence, it has been exploited in the diagnosis and treatment of whiplash injuries as well as for headaches of unknown origin. Evidence is presented that the original anatomic proposition was erroneous and that the C2 root is not exposed and is not vulnerable. Indeed, a survey of the "worst" traumatic and pathologic disruptions of the craniospinal junction shows that although they would be expected to injure the C2 root, in fact, they do not. The theory as well as the operations based upon it, particularly intradural section of the C2 root, should be abandoned.
D002574:Cervical Vertebrae / Q000294:innervation; D006801:Humans; D009777:Occipital Bone / Q000294:innervation; D010146:Pain / Q000503:physiopathology; D013131:Spine / Q000473:pathology; D014911:Whiplash Injuries / Q000503:physiopathology / Q000601:surgery*