C2 nerve root transection during C1 lateral mass screw fixation: does it affect functionality and quality of life?
BACKGROUND
Sectioning of the C2 nerve root allows for direct visualization of the C1-2 joint and may facilitate arthrodesis.


OBJECTIVE
To determine the clinical and functional consequences of C2 nerve root sectioning during placement of C1 lateral mass screws.


METHODS
All patients undergoing C1 lateral mass screw fixation were included in this prospective study. A standard questionnaire was used to determine the severity of occipital numbness/pain and its effect on quality of life (QOL). Domains of the neck disability index were used to assess the disability related to C2 symptoms.


RESULTS
A total of 28 patients were included (C2 transection, 8; C2 preservation, 20). A trend of decreased blood loss and length of surgery was observed in the C2 transection cohort. Occipital numbness was reported by 4 (50.0%) patients after C2 transection. Occipital neuralgia was reported by 7 (35.0%) patients with C2 preservation. None of the patients with numbness after C2 transection reported being "bothered" by it. All patients with occipital neuralgia after C2 sparing reported being "bothered" by it, and 57.1% reported a moderate to severe effect on QOL. The use of medication was reported by 5 (71.4%) patients with neuralgia vs none with numbness. Mean disability was significantly higher with neuralgia vs numbness (P = .016).


CONCLUSIONS
C2 nerve root transection is associated with increased occipital numbness but this has no effect on patient-reported outcomes and QOL. C2 nerve root preservation can be associated with occipital neuralgia, which has a negative impact on patient disability and QOL. C2 nerve root transection has no negative consequences during C1-2 stabilization.
*Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee; ‡Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina; §Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Michael C
MC
Dewan
Saniya S
SS
Godil
Stephen K
SK
Mendenhall
Clinton J
CJ
Devin
Matthew J
MJ
McGirt
D001268:Atlanto-Axial Joint / Q000293:injuries / Q000601:surgery*; D001863:Bone Screws; D015331:Cohort Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D006987:Hypesthesia / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D007593:Joint Instability / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology*; D009437:Neuralgia / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D061646:Operative Time; D059351:Organ Sparing Treatments; D010147:Pain Measurement; D011446:Prospective Studies; D011788:Quality of Life; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D013126:Spinal Nerve Roots / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D011795:Surveys and Questionnaires; D016896:Treatment Outcome