Does Transection of the C2 Nerve Roots during C1 Lateral Mass Screw Placement for Atlantoaxial Fixation Result in a Superior Outcome?

Jetan H. Badhiwala, Farshad Nassiri, Christopher D. Witiw, Seyed Alireza Mansouri, Saleh A. Almenawer, Michael G. Fehlings

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

Study Design. Systematic review and meta-analysis. Objective. To evaluate the clinical and functional outcomes of transection of the C2 roots during C1 lateral mass screw placement for atlantoaxial fixation. Summary of Background Data. Transection of the C2 nerve roots has been recommended during atlantoaxial fixation to facilitate C1 lateral mass screw placement and possibly reduce postoperative occipital neuralgia, although this practice remains controversial. Methods. We searched MEDLINE, EMBASE, Web of Science, and the Cochrane Library for studies evaluating the outcomes of C1-2 fixation involving sacrifice of the C2 roots. We calculated transformed proportions with 95% confidence intervals (CI) for the outcomes of occipital neuralgia, numbness, bony fusion, and procedural morbidity. For studies comparing C2 transection with nerve sparing surgery, we performed meta-analyses for the outcomes of occipital neuralgia, occipital numbness, blood loss, and operative time. Results. Eight observational studies (N=393) met eligibility criteria. The rate of postoperative occipital neuralgia among included studies was 0% to 25%; occipital numbness, 6.7% to100%; bony fusion, 96.7% to 100%; and procedural morbidity, 0% to 14.3%. Among comparative studies, C2 transection was associated with a higher rate of occipital numbness [odds ratio (OR) 178.6 (95% CI 26.6 to 1198.4)], lower blood loss [mean difference (MD) -195.3mL (95% CI -317.7 to -72.8mL)] and shorter operative times [MD -57.5mins (95% CI -76.9 to -38.2mins)] than when the C2 roots were spared. We found no difference in rates of occipital neuralgia [OR 1.44 (95% CI 0.45 to 4.68)]. Conclusion. Transection of the C2 nerve roots appears to be a viable, safe option when undertaking placement of C1 lateral mass screws. The procedure is associated with reduced operative duration and blood loss, increased rate of occipital numbness, and no change in the rate of occipital neuralgia. However, given the relatively low quality of evidence, prospective, controlled studies to evaluate this strategy are recommended.

Original languageEnglish (US)
Pages (from-to)E1067-E1076
JournalSpine
Volume42
Issue number18
DOIs
StatePublished - Sep 15 2017

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Neuralgia
Hypesthesia
Confidence Intervals
Operative Time
Meta-Analysis
Odds Ratio
Library Science
Morbidity
MEDLINE
Observational Studies
Outcome Assessment (Health Care)
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Badhiwala, Jetan H. ; Nassiri, Farshad ; Witiw, Christopher D. ; Mansouri, Seyed Alireza ; Almenawer, Saleh A. ; Fehlings, Michael G. / Does Transection of the C2 Nerve Roots during C1 Lateral Mass Screw Placement for Atlantoaxial Fixation Result in a Superior Outcome?. In: Spine. 2017 ; Vol. 42, No. 18. pp. E1067-E1076.
@article{cd137b172ecf470499958adc6eb67043,
title = "Does Transection of the C2 Nerve Roots during C1 Lateral Mass Screw Placement for Atlantoaxial Fixation Result in a Superior Outcome?",
abstract = "Study Design. Systematic review and meta-analysis. Objective. To evaluate the clinical and functional outcomes of transection of the C2 roots during C1 lateral mass screw placement for atlantoaxial fixation. Summary of Background Data. Transection of the C2 nerve roots has been recommended during atlantoaxial fixation to facilitate C1 lateral mass screw placement and possibly reduce postoperative occipital neuralgia, although this practice remains controversial. Methods. We searched MEDLINE, EMBASE, Web of Science, and the Cochrane Library for studies evaluating the outcomes of C1-2 fixation involving sacrifice of the C2 roots. We calculated transformed proportions with 95{\%} confidence intervals (CI) for the outcomes of occipital neuralgia, numbness, bony fusion, and procedural morbidity. For studies comparing C2 transection with nerve sparing surgery, we performed meta-analyses for the outcomes of occipital neuralgia, occipital numbness, blood loss, and operative time. Results. Eight observational studies (N=393) met eligibility criteria. The rate of postoperative occipital neuralgia among included studies was 0{\%} to 25{\%}; occipital numbness, 6.7{\%} to100{\%}; bony fusion, 96.7{\%} to 100{\%}; and procedural morbidity, 0{\%} to 14.3{\%}. Among comparative studies, C2 transection was associated with a higher rate of occipital numbness [odds ratio (OR) 178.6 (95{\%} CI 26.6 to 1198.4)], lower blood loss [mean difference (MD) -195.3mL (95{\%} CI -317.7 to -72.8mL)] and shorter operative times [MD -57.5mins (95{\%} CI -76.9 to -38.2mins)] than when the C2 roots were spared. We found no difference in rates of occipital neuralgia [OR 1.44 (95{\%} CI 0.45 to 4.68)]. Conclusion. Transection of the C2 nerve roots appears to be a viable, safe option when undertaking placement of C1 lateral mass screws. The procedure is associated with reduced operative duration and blood loss, increased rate of occipital numbness, and no change in the rate of occipital neuralgia. However, given the relatively low quality of evidence, prospective, controlled studies to evaluate this strategy are recommended.",
author = "Badhiwala, {Jetan H.} and Farshad Nassiri and Witiw, {Christopher D.} and Mansouri, {Seyed Alireza} and Almenawer, {Saleh A.} and Fehlings, {Michael G.}",
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pages = "E1067--E1076",
journal = "Spine",
issn = "0362-2436",
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Does Transection of the C2 Nerve Roots during C1 Lateral Mass Screw Placement for Atlantoaxial Fixation Result in a Superior Outcome? / Badhiwala, Jetan H.; Nassiri, Farshad; Witiw, Christopher D.; Mansouri, Seyed Alireza; Almenawer, Saleh A.; Fehlings, Michael G.

In: Spine, Vol. 42, No. 18, 15.09.2017, p. E1067-E1076.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Does Transection of the C2 Nerve Roots during C1 Lateral Mass Screw Placement for Atlantoaxial Fixation Result in a Superior Outcome?

AU - Badhiwala, Jetan H.

AU - Nassiri, Farshad

AU - Witiw, Christopher D.

AU - Mansouri, Seyed Alireza

AU - Almenawer, Saleh A.

AU - Fehlings, Michael G.

PY - 2017/9/15

Y1 - 2017/9/15

N2 - Study Design. Systematic review and meta-analysis. Objective. To evaluate the clinical and functional outcomes of transection of the C2 roots during C1 lateral mass screw placement for atlantoaxial fixation. Summary of Background Data. Transection of the C2 nerve roots has been recommended during atlantoaxial fixation to facilitate C1 lateral mass screw placement and possibly reduce postoperative occipital neuralgia, although this practice remains controversial. Methods. We searched MEDLINE, EMBASE, Web of Science, and the Cochrane Library for studies evaluating the outcomes of C1-2 fixation involving sacrifice of the C2 roots. We calculated transformed proportions with 95% confidence intervals (CI) for the outcomes of occipital neuralgia, numbness, bony fusion, and procedural morbidity. For studies comparing C2 transection with nerve sparing surgery, we performed meta-analyses for the outcomes of occipital neuralgia, occipital numbness, blood loss, and operative time. Results. Eight observational studies (N=393) met eligibility criteria. The rate of postoperative occipital neuralgia among included studies was 0% to 25%; occipital numbness, 6.7% to100%; bony fusion, 96.7% to 100%; and procedural morbidity, 0% to 14.3%. Among comparative studies, C2 transection was associated with a higher rate of occipital numbness [odds ratio (OR) 178.6 (95% CI 26.6 to 1198.4)], lower blood loss [mean difference (MD) -195.3mL (95% CI -317.7 to -72.8mL)] and shorter operative times [MD -57.5mins (95% CI -76.9 to -38.2mins)] than when the C2 roots were spared. We found no difference in rates of occipital neuralgia [OR 1.44 (95% CI 0.45 to 4.68)]. Conclusion. Transection of the C2 nerve roots appears to be a viable, safe option when undertaking placement of C1 lateral mass screws. The procedure is associated with reduced operative duration and blood loss, increased rate of occipital numbness, and no change in the rate of occipital neuralgia. However, given the relatively low quality of evidence, prospective, controlled studies to evaluate this strategy are recommended.

AB - Study Design. Systematic review and meta-analysis. Objective. To evaluate the clinical and functional outcomes of transection of the C2 roots during C1 lateral mass screw placement for atlantoaxial fixation. Summary of Background Data. Transection of the C2 nerve roots has been recommended during atlantoaxial fixation to facilitate C1 lateral mass screw placement and possibly reduce postoperative occipital neuralgia, although this practice remains controversial. Methods. We searched MEDLINE, EMBASE, Web of Science, and the Cochrane Library for studies evaluating the outcomes of C1-2 fixation involving sacrifice of the C2 roots. We calculated transformed proportions with 95% confidence intervals (CI) for the outcomes of occipital neuralgia, numbness, bony fusion, and procedural morbidity. For studies comparing C2 transection with nerve sparing surgery, we performed meta-analyses for the outcomes of occipital neuralgia, occipital numbness, blood loss, and operative time. Results. Eight observational studies (N=393) met eligibility criteria. The rate of postoperative occipital neuralgia among included studies was 0% to 25%; occipital numbness, 6.7% to100%; bony fusion, 96.7% to 100%; and procedural morbidity, 0% to 14.3%. Among comparative studies, C2 transection was associated with a higher rate of occipital numbness [odds ratio (OR) 178.6 (95% CI 26.6 to 1198.4)], lower blood loss [mean difference (MD) -195.3mL (95% CI -317.7 to -72.8mL)] and shorter operative times [MD -57.5mins (95% CI -76.9 to -38.2mins)] than when the C2 roots were spared. We found no difference in rates of occipital neuralgia [OR 1.44 (95% CI 0.45 to 4.68)]. Conclusion. Transection of the C2 nerve roots appears to be a viable, safe option when undertaking placement of C1 lateral mass screws. The procedure is associated with reduced operative duration and blood loss, increased rate of occipital numbness, and no change in the rate of occipital neuralgia. However, given the relatively low quality of evidence, prospective, controlled studies to evaluate this strategy are recommended.

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U2 - 10.1097/BRS.0000000000002069

DO - 10.1097/BRS.0000000000002069

M3 - Review article

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AN - SCOPUS:85009726352

VL - 42

SP - E1067-E1076

JO - Spine

JF - Spine

SN - 0362-2436

IS - 18

ER -