C2 nerve root sectioning in posterior C1-2 instrumented fusions

Area of Science:

• Neurosurgery
• Spinal Fusion
• Cervical Spine Surgery

Background:

• Posterior atlantoaxial instrumented fusions are common for treating C1-2 instability.
• The C2 nerve root is often sacrificed to facilitate fusion and improve surgical access.
• The clinical consequences of C2 nerve transection require thorough evaluation.

Purpose of the Study:

• To qualitatively analyze C2 nerve dysfunction following its transection in C1-2 posterolateral instrumented fusions.
• To assess the safety and efficacy of C2 nerve sacrifice in this surgical context.

Main Methods:

• A consecutive series of 20 patients undergoing C1-2 posterolateral instrumented fusions between 2002-2010 were analyzed.
• Bilateral C2 nerve roots were intentionally coagulated and transected in all patients.
• Follow-up included clinical, radiographic, and patient-reported outcome assessments (VAS) for C2 nerve dysfunction.

Main Results:

• No unintended neurologic deficits, vascular injuries, CSF leaks, or hardware issues occurred.
• Transient C2 nerve related sensory disturbances (4/20) and paresthesias (2/20) were reported early postoperatively.
• Long-term follow-up revealed only one additional patient with mild sensory symptoms and no neuropathic pain.
• Fusion was achieved in all patients with 12 months follow-up.

Conclusions:

• Sacrifice of the C2 nerve root in C1-2 posterolateral instrumented fusions is clinically safe.
• C2 nerve transection enhances the fusion surface, improves surgical preparation, visualization, and reduces operative time.
• This technique leads to favorable surgical outcomes without significant long-term C2 nerve dysfunction or adverse impact on quality of life.