C1-C2 fusion: postoperative C2 nerve impingement-is it a problem?

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Fusion Techniques

Background:

• Lateral mass screw fixation offers rigid fixation for atlantoaxial fusion with high success rates.
• Potential neurological damage is a risk during screw fixation due to proximity of vital structures like the spinal cord and vertebral artery.
• Careful surgical planning is essential to mitigate risks associated with atlantoaxial fusion procedures.

Observation:

• A comparison case study reviewed two patients undergoing the same atlantoaxial fusion procedure.
• One patient experienced no complications, while the second required revision surgery due to C1 screw impingement on the exiting C1 nerve.
• The C1 screw in the second patient encroached upon the C1 nerve foramen, causing neurological symptoms.

Findings:

• Revision surgery involving C1 screw removal and conversion to a cable technique successfully restored neurological function.
• The patient who underwent revision surgery experienced a full recovery after the C1 screw was removed.
• Successful neurological recovery was achieved by addressing the nerve impingement.

Implications:

• Preoperative assessment of the C1 nerve foramen size is critical before C1-C2 lateral mass screw fixation.
• If the foramen is significantly narrowed, alternative fixation methods should be considered to prevent nerve impingement.
• This highlights the importance of anatomical evaluation in preventing surgical complications during atlantoaxial fusion.