Routine Sectioning of the C2 Nerve Root and Ganglion for C1 Lateral Mass Screw Placement in Children: Surgical and Functional Outcomes, and Patient Satisfaction

Akash J. Patel, MD1, Jerome Boatey, MD1, Alison Brayton1, Andrew Jea, MD1

1Houston, TX United States

Keywords: spinal fusion, survey, outcome, technique, cervical spine

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     Transarticular screw fixation can successfully treat atlantoaxial and craniovertebral instability in children. Adult studies have shown that sectioning the C2 nerve root and ganglion, which facilitates placement of C1 lateral mass screws, can decrease operative time and blood loss (EBL).
     Functional outcomes and complications following sectioning of the C2 nerve root and ganglion have not been reported in children.
     Fifteen consecutive pediatric patients (mean age 12.6 years) underwent bilateral C2 nerve root and ganglion sectioning to facilitate C1 lateral mass screw insertion.
     Clinical and radiographic assessments were performed at follow-up. Numbness in the C2 distribution and/or occipital neuralgia was assessed. Operative times, EBL, length of stay (LOS), and complications were recorded.
     Average follow-up time was 29.8 months (range 2-47 months). Mean operative time was 251.73 minutes (range 124-472 minutes), mean LOS was 8.46 days (range 5-17 days), and mean EBL was 343.6cc (range 20-1100 cc). There were no intraoperative complications, and no patient reported new onset occipital neuralgia or numbness in the C2 distribution. Fourteen of 15 patients achieved Lenke fusion grade A.
     This is a retrospective study.
     In our series of pediatric patients, sectioning of the C2 nerve root and ganglion enhanced surgical exposure of the C1 lateral mass and C1-1 facet joint, maximizing fusion rate and minimizing intraoperative complications.
     This technique may improve operative times, EBL, and LOS in children undergoing C1 lateral mass screw insertion. Sectioning of the C2 nerve root and ganglion did not negatively affect functional outcome in these patients.


Project Roles:

A. Patel (), J. Boatey (), A. Brayton (), A. Jea ()