Introduction: Posterior atlantoaxial stabilization via C1 lateral mass screw fixation can be technically challenging. Sectioning of the C2 nerve root allows for direct visualization of the C1-2 joint and may facilitate arthrodesis. We set out to determine the clinical and functional consequences of routine sectioning of C2 nerve root during placement of C1 lateral mass screws.
Methods: All patients who underwent posterior atlantoaxial stabilization via C1 lateral mass screw fixation were included in the study. Data was prospectively collected on patient demographics, surgical variables, and clinical outcome. A standard questionnaire was used to determine the severity of posterior auricular numbness or pain, and its effect on quality of life. Domains of NDI were used to assess disability related to C2 symptoms.
Results: A total of 28 patients were included(C2 transection=8; C2 preservation=20). Groups were similar at baseline. A trend of decreased blood loss and length of surgery was observed in the C2 transection cohort. Posterior auricular numbness was reported by 4(50.0%) patients after C2 transection. Posterior auricular 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 7 patients with posterior auricular neuralgia after C2 sparing reported being “bothered” by it daily and 57.1% reported moderate to severe effect on QOL. Use of medication was reported by 5(71.4%) patients with posterior auricular neuralgia vs none with numbness. Mean disability score was significantly higher with posterior auricular neuralgia versus numbness(p=0.016).
Conclusions: C2 nerve root transection is associated with increased post auricular numbness but this has no effect on PROs and QOL. C2 nerve root preservation can be associated with posterior auricular neuralgia which has a negative impact on patient disability and quality of life. Our experience suggests no negative consequences with C2 nerve root transection during C1-2 stabilization and arthrodesis.
Patient Care: Our research highlights that C2 nerve root transection during C1-2 stabilization and arthrodesis has no negative consequences on outcomes and functionality of patients. It can be used routinely to facilitate C1-C2 arthrodesis.
Learning Objectives: At the end of the session, participants should be able to: 1) Determine the consequences of routine C2 transection during lateral mass screw placement; 2) Identify that C2 transection does not have any major consequences on outcomes and functionality.