title: 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: METHODS
  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.
  
  
  BACKGROUND
  We are not aware of any report concerning C2 root decompression during C1-C2 fusion.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: *Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Korea†Department of Orthopaedic Surgery, Columbia University Medical Center and New York Presbyterian Hospital, New York, NY‡Department of Orthopaedic Surgery, Kangwon National University Hospital, Chuncheon, Korea§Department of Orthopaedic Surgery, Armed Forces Yangju Hospital, Yangju, Korea; and¶Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea.
authors.forename: Jin S
authors.initials: JS
authors.lastname: Yeom
authors.forename: K Daniel
authors.initials: KD
authors.lastname: Riew
authors.forename: Sung Shik
authors.initials: SS
authors.lastname: Kang
authors.forename: Jemin
authors.initials: J
authors.lastname: Yi
authors.forename: Gun Woo
authors.initials: GW
authors.lastname: Lee
authors.forename: Arim
authors.initials: A
authors.lastname: Yeom
authors.forename: Bong-Soon
authors.initials: BS
authors.lastname: Chang
authors.forename: Choon-Ki
authors.initials: CK
authors.lastname: Lee
authors.forename: Ho-Joong
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D001368:Axis, Cervical Vertebra / Q000601:surgery*; D001863:Bone Screws; D001270:Cervical Atlas / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000209:etiology / Q000601:surgery*; D011446:Prospective Studies; D011843:Radiculopathy / Q000150:complications / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000601:surgery