Post-operative morbidity after C2 nerve root sacrifice during C1-2 fixation in pediatric atlantoaxial instability

Document Type : Original Articles

Authors

1 Neurosurgery Department, Faculty of Medicine, Alexandria University, Egypt

2 Neurosurgery Department, Faculty of Medicine, Alexandria University.

3 Neurosurgery Department, Faculty of Medicine, Alexandria University

Abstract

Background: The presence of the C2 root ganglion with its surrounding venous plexus at the region of C1-2 joint makes surgical dissection technically demanding. Although it may result in occipital sensory deficits, C2 ganglion neurectomy improves visualization of the C1-C2 joint and allows for control of venous bleeding. Therefore, the clinical benefits of C2 ganglion neurectomy in C1-C2 fixation are still controversial.
Purpose: To investigate the clinical outcome of pediatric atlantoaxial instrumentation using the Goel-Harms technique after C2 root sacrifice.
Methods: This is a prospective cohort study including 20 pediatric patients with atlantoaxial instability. Outcome was assessed by VAS score for neck pain, in addition to sensory examination of the occipital region for assessment of any sensory deficits.
Results: The mean operative time was 145 ± 16.38 minutes. The mean estimated blood loss was 211.5 ± 13.5 ml.
13 cases (65%) had early occipital anaesthesia, while 7 cases (35%) had occipital dysesthesia.
After 2 years of follow-up, resolution of sensory deficits was the rule in most cases, while only 4 cases had mild occipital dysesthesia.
VAS score for neck pain has improved significantly from a mean preoperative of 6.15 ± 0 .93 to a mean 2 years postoperative of 1.30 ± 0.66 (p<0.001)
Conclusion: C2 root sectioning during C1-2 fixation leads to better visualization of the C1 lateral mass besides less blood loss, but leads to early postoperative sensory deficits. However, complete resolution of these deficits was the rule in most cases after 2 years of follow-up.

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