Use of a Self-Irrigating Bipolar Sealer for Bilateral C2 Nerve Root Ligation During Atlantoaxial Instrumented Fusion

Background This research involves the analysis of a novel surgical technique using a commercial self-irrigating bipolar sealer for ligation of the C2 nerve-venous complex during atlantoaxial fixation. Methods For this retrospective analysis, surgical exposure of C1-2 was performed via an open approach. The C2 nerve root and perineural venous plexus were coagulated with the bipolar sealer at 100-140 watts for 10-30 seconds and cut using microscissors, fully exposing the C1-2 facet joints to allow instrumentation of the C1 lateral masses and C2 pars and pedicles under direct visualization. Arthrodesis was accomplished within the exposed C1-2 joint spaces. Results Data are presented as mean (standard deviation (SD)). Twenty-seven patients (15 men, 12 women) with a mean age of 71.6 (8.6) years and mean body mass index 28.6 (6.4) underwent atlantoaxial fixation and ligation of the C2 nerve roots, either in isolation or as part of longer constructs. The mean operative time was 126.4 (55.9) minutes; the estimated blood loss (EBL) was 82 (72) mL. For C1-2 fusion only, the mean operative time and EBL were 113.5 (55.9) minutes and 49 (25) mL, respectively. The mean time to complete exposure of the C1-2 joint was 2.3 (0.9) minutes. No perioperative or postoperative complications were noted, except C2 dermatome numbness without dysesthesia. Conclusions C2 nerve root coagulation and ligation with the self-irrigating bipolar sealer was safe and effective for maximizing exposure and minimizing EBL during atlantoaxial instrumentation among the selected patients. This novel technique provided optimal rapid exposure of the atlantoaxial joint, allowing accurate placement of instrumentation and direct decortication of the facet joints while demonstrating no vertebral artery injury or other neurovascular sequelae.