Reoperation following Primary Greater Occipital Nerve Decompression Surgery: Incidence, Risk Factors, and Outcomes

Although nerve decompression surgery is an effective treatment for refractory occipital neuralgia, a proportion of patients experience recurrence of pain and undergo reoperation. This study analyzes the incidence, risk factors, and outcomes of reoperation following primary greater occipital nerve (GON) decompression.

A total of 215 patients who underwent 399 primary GON decompressions were prospectively enrolled. Data included patient demographics, medical and surgical history, reoperation rates, intraoperative findings, surgical technique, and postoperative outcomes in terms of pain frequency (days per month), duration (hours per day), intensity (scale, 0 to 10), and migraine headache index. Bivariate analyses, univariable logistic regression analysis, and multivariable logistic regression analysis, were performed.

Twenty-seven GON decompressions (6.8%) required reoperation with neurectomy at a median follow-up time of 15.5 months (range, 9.8 to 40.5 months). Cervical spine disorders on imaging that did not warrant surgical intervention (OR, 4.88; 95% CI, 1.61 to 14.79; P < 0.01) and radiofrequency ablation (OR, 4.20; 95% CI, 1.45 to 15.2; P < 0.05) were significantly associated with higher rates of reoperation. At 12 months postoperatively, patients who underwent reoperation achieved similar mean reductions in pain frequency, duration, intensity, and migraine headache index, as compared with patients who underwent only primary decompression ( P > 0.05).

Patients with occipital neuralgia who have a history of cervical spine disorders or radiofrequency ablation should be counseled that primary decompression has a higher risk of reoperation, but outcomes are ultimately comparable.

Risk, III.