C2 Nerve Root Resection to Achieve Safe and Wide Exposure of Lateral Atlantoaxial Joints in Posterior C1-2 Instrumented Fixation: Technical Note

Posterior atlantoaxial (C1-2) fixation with individual screw placement in C1 and C2 has been one of the technical options to treat C1-2 subluxation or instability. In the present study, we demonstrate the surgical technique of C2 nerve root resection to avoid the troublesome bleeding from the perivertebral venous plexus and achieve full exposure of the lateral C1-2 joints. The present study includes a series of 16 consecutive patients who underwent posterior C1-2 instrumented fixation with individual screw placement in C1 and C2. All patients underwent unilateral or bilateral C2 nerve root resection at the sensory ganglion. Screw malposition resulting in vascular or neural injury was not encountered. Sensory pain scale analysis indicated that the mean score before surgery was 2.4, which significantly improved to 1.4 after surgery. No patients reported allodynia or C2 distribution neuropathic pain during the follow-up. C2 nerve root resection resulted in early postoperative dysesthesia in all 16 patients; however, neurological examination during the follow-up revealed that only 12.5% of all analyzed patients did not demonstrate satisfactory recovery of C2 sensory disturbance. Postoperative radiologic analysis revealed solid osseous or partial fusion at the lateral C1-2 joints in all cases during the follow-up. No case demonstrated non-union with pseudoarthrosis. Although C2 nerve root resection is still under debate and not fully justified, the present study suggests that C2 nerve root resection does not always result in significant morbidity and can be an option for surgical resolution to achieve safe and wide exposure of lateral C1-2 joints.