Study supports C2 nerve root transection as viable option during lateral mass screw fixation

NEW ORLEANS — The results of a prospective, nonrandomized single-center study presented here indicate C2 nerve root transection during C1 lateral mass screw fixation did not significantly impact patient-reported function.

"This early finding would suggest that you can sacrifice C2 nerve roots bilaterally," Matthew J. McGirt, MD, said at the North American Spine Society Annual Meeting. "In a subset of half the patients, you will get numbness; but it will not have a functional significance or bothersome effect on the patient. [Nerve transection] is a viable option in our hands at a single center, and this will vary as surgeon quality and different approaches vary. But even with careful meticulous dissection, some unintended posterior auricular neuralgia or symptoms [can occur and should be] carefully studied prospectively with patient-centered outcome measures."

Matthew McGirt

The investigators studied 20 patients who underwent bilateral transection of the C2 nerve root performed by one surgeon and eight patients who had the C2 nerve root preserved by procedures performed by two other surgeons. The patient groups had similar baseline characteristics. In addition to collecting surgical and clinical data on the patients, the researchers sent the patients a standard questionnaire about posterior auricular numbness or pain and its influence on their lives."

Operative data revealed a 30% reduction in blood loss and in operative time for patients who underwent C2 nerve root transsections compared with the nerve preservation group. The investigators also found that half of the patients in the transection group had posterior auricular numbness, while no patients in the preservation group reported this.

"But interestingly half of patients — despite having both C2 nerve roots cut — at a median follow-up of 26 months, reported no numbness at the posterior auricular neuralgia areas at all, showing that it can be tolerated," McGirt said. He added, "Those who had C2 nerve root transection, while half of them did at this point did explain that they had numbness, none of them reported that the pain was bothersome and none of them reported any disability scores that would be considered moderate to severe. However, those who underwent preservation about a third described possible symptoms of dysfunction. All of them required medication. All of them had some pain related disability from that."

Reference:

Dewan MC. C2 nerve root transection during C1 lateral mass screw fixation: Does it affect functionality and quality of life? Presented at: North American Spine Society Annual Meeting; Oct. 9-12; New Orleans.

Disclosure: McGirt has no relevant financial disclosures.