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Modified C1 lateral mass screw insertion using a high entry point to avoid postoperative occipital neuralgia
Sun-Ho Lee1, Eun-Sang Kim, Whan Eoh
1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea. sobotta72@hotmail.com
Summary
A modified screw entry point for C1 lateral mass fixation may prevent occipital neuralgia. This atlantoaxial stabilization technique showed promising results with minimal complications and no construct failure.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Screw-rod constructs are common for atlantoaxial joint stabilization.
- Standard C1 lateral mass screw insertion can lead to occipital neuralgia.
Purpose of the Study:
- To evaluate if a higher screw entry point for C1 lateral mass fixation prevents occipital neuralgia.
- To assess clinical and radiological outcomes of modified C1 screw placement.
Main Methods:
- 12 patients underwent bilateral C1 lateral mass fixation with a modified screw entry point.
- Postoperative parameters, complications, and neuralgia occurrence were recorded.
- Radiographs assessed screw positioning and construct integrity.
Main Results:
- No patient experienced significant occipital neuralgia; one had mild, transient neuralgia.
- No vertebral artery injury, CSF leak, or construct failure occurred.
- Most screws were correctly positioned, though some had minor malplacement.
Conclusions:
- A higher screw entry point for C1 lateral mass fixation may reduce the risk of occipital neuralgia.
- This modified technique appears safe and effective for atlantoaxial stabilization.
- Surgeons should consider this approach to mitigate screw-induced neuralgia.
