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C-2 neurectomy during atlantoaxial instrumented fusion in the elderly: patient satisfaction and surgical outcome.

Publication ,  Journal Article
Hamilton, DK; Smith, JS; Sansur, CA; Dumont, AS; Shaffrey, CI
Published in: J Neurosurg Spine
July 2011

OBJECTIVE: The originally described technique of atlantoaxial stabilization using C-1 lateral mass and C-2 pars screws includes a C-2 neurectomy to provide adequate hemostasis and visualization for screw placement, enable adequate joint decortication and arthrodesis, and prevent new-onset postoperative C-2 neuralgia. However, inclusion of a C-2 neurectomy for this procedure remains controversial, likely due in part to a lack of studies that have specifically addressed whether it affects patient outcome. The authors' objective was to assess the surgical and clinical impact of routine C-2 neurectomy performed with C1-2 segmental instrumented arthrodesis in a consecutive series of elderly patients with C1-2 instability. METHODS: Forty-four consecutive patients (mean age 71 years) underwent C1-2 instrumented fusion, including C-1 lateral mass screw insertion. Bilateral C-2 neurectomies were performed. Standardized clinical assessments were performed both pre- and postoperatively. Numbness or discomfort in a C-2 distribution was documented at follow-up. Fusion was assessed using the Lenke fusion grade. RESULTS: Among all 44 patients, mean blood loss was 200 ml (range 100-350 ml) and mean operative time was 129 minutes (range 87-240 minutes). There were no intraoperative complications, and no patients reported new postoperative onset or worsening of C-2 neuralgia postoperatively. Outcomes for the 30 patients with a minimum 13-month follow-up (range 13-72 months) were assessed. At a mean follow-up of 36 months, Nurick grade and pain numeric rating scale scores improved from 3.7 to 1.0 (p < 0.001) and 9.4 to 0.6 (p < 0.001), respectively. The mean postoperative Neck Disability Index score was 7.3%. The fusion rate was 97%, and the patient satisfaction rate was 93%. All 24 patients with preoperative occipital neuralgia reported relief. Seventeen patients noticed C-2 distribution numbness only during examination in the clinic, and 2 patients reported C-2 numbness, but it did not affect their daily function. CONCLUSIONS: In this series of C1-2 instrumented arthrodesis in elderly patients, excellent fusion rates were achieved, and patient satisfaction was not negatively affected by C-2 neurectomy. In the authors' experience, C-2 neurectomy enhanced surgical exposure of the C1-2 joint, thereby facilitating hemostasis, placement of instrumentation, and decortication of the joint space for arthrodesis. Importantly, with C-2 neurectomy in the present series, no cases of new onset postoperative C-2 neuralgia occurred, in contrast to a growing number of reports in the literature documenting new-onset C-2 neuralgia without C-2 neurectomy. On the contrary, 80% of patients in the present series had preoperative occipital neuralgia and in all of these patients this neuralgia was relieved following C1-2 instrumented arthrodesis with C-2 neurectomy.

Duke Scholars

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

July 2011

Volume

15

Issue

1

Start / End Page

3 / 8

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spinal Fusion
  • Spinal Fractures
  • Patient Satisfaction
  • Orthopedics
  • Odontoid Process
  • Neurosurgical Procedures
  • Male
  • Joint Instability
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hamilton, D. K., Smith, J. S., Sansur, C. A., Dumont, A. S., & Shaffrey, C. I. (2011). C-2 neurectomy during atlantoaxial instrumented fusion in the elderly: patient satisfaction and surgical outcome. J Neurosurg Spine, 15(1), 3–8. https://doi.org/10.3171/2011.1.SPINE10417
Hamilton, D Kojo, Justin S. Smith, Charles A. Sansur, Aaron S. Dumont, and Christopher I. Shaffrey. “C-2 neurectomy during atlantoaxial instrumented fusion in the elderly: patient satisfaction and surgical outcome.J Neurosurg Spine 15, no. 1 (July 2011): 3–8. https://doi.org/10.3171/2011.1.SPINE10417.
Hamilton DK, Smith JS, Sansur CA, Dumont AS, Shaffrey CI. C-2 neurectomy during atlantoaxial instrumented fusion in the elderly: patient satisfaction and surgical outcome. J Neurosurg Spine. 2011 Jul;15(1):3–8.
Hamilton, D. Kojo, et al. “C-2 neurectomy during atlantoaxial instrumented fusion in the elderly: patient satisfaction and surgical outcome.J Neurosurg Spine, vol. 15, no. 1, July 2011, pp. 3–8. Pubmed, doi:10.3171/2011.1.SPINE10417.
Hamilton DK, Smith JS, Sansur CA, Dumont AS, Shaffrey CI. C-2 neurectomy during atlantoaxial instrumented fusion in the elderly: patient satisfaction and surgical outcome. J Neurosurg Spine. 2011 Jul;15(1):3–8.

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

July 2011

Volume

15

Issue

1

Start / End Page

3 / 8

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spinal Fusion
  • Spinal Fractures
  • Patient Satisfaction
  • Orthopedics
  • Odontoid Process
  • Neurosurgical Procedures
  • Male
  • Joint Instability
  • Humans