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Occipital neuralgia after occipital cervical fusion to treat an unstable jefferson fracture.

Kong SJ, Park JH, Roh SW - Korean J Spine (2012)

Bottom Line: We performed bilateral C2 root decompression via a C1 laminectomy.After decompression, bilateral C2 root redundancy was identified by palpation.After decompression surgery, pain was reduced.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.

ABSTRACT
In this report we describe a patient with an unstable Jefferson fracture who was treated by occipitocervical fusion and later reported sustained postoperative occipital neuralgia. A 70-year-old male was admitted to our center with a Jefferson fracture induced by a car accident. Preoperative lateral X-ray revealed an atlanto-dens interval of 4.8mm and a C1 canal anterior-posterior diameter of 19.94mm. We performed fusion surgery from the occiput to C5 without decompression of C1. The patient reported sustained continuous pain throughout the following year despite strong analgesics. The pain dermatome was located mainly in the great occipital nerve territory and posterior neck. Magnetic resonance images revealed no evidence of cord compression, however a C1 lamina compressed dural sac and C2 root compression could not be excluded. We performed bilateral C2 root decompression via a C1 laminectomy. After decompression, bilateral C2 root redundancy was identified by palpation. After decompression surgery, pain was reduced. This case indicates that occipital neuralgia, suggesting the need for diagnostic block, should be considered in the differential diagnosis of patients with sustained occipital headache after occipitocervical fusion surgery.

No MeSH data available.


Related in: MedlinePlus

(A) Preoperative open mouth view, showing a 7.26 mm displacement of the left C1 lateral mass to the C2 lateral mass. (B) Preoperative lateral X-ray showing a 4.39 mm atlanto-dens interval and a C1 canal diameter of 20.20mm. (C) Preoperative T2-weighted midline magnetic resonance sagittal image showing an absence of cord compression. (D) Preoperative T2-weighted magnetic resonance axial image at C1-C2 level revealing a Jefferson fracture, injury to the transverse ligament, and dural compression of the left side fractured lamina.
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Figure 1: (A) Preoperative open mouth view, showing a 7.26 mm displacement of the left C1 lateral mass to the C2 lateral mass. (B) Preoperative lateral X-ray showing a 4.39 mm atlanto-dens interval and a C1 canal diameter of 20.20mm. (C) Preoperative T2-weighted midline magnetic resonance sagittal image showing an absence of cord compression. (D) Preoperative T2-weighted magnetic resonance axial image at C1-C2 level revealing a Jefferson fracture, injury to the transverse ligament, and dural compression of the left side fractured lamina.

Mentions: A 70-year-old male was admitted to our center with a Jefferson fracture caused by a car accident. The patient reported neck pain with an intensity of 7-8 on a visual analog scale ranging from 0-10, without any neurological deficit other than combined injury. A preoperative open mouth view showed a 7.26mm lateral displacement of the C1 to the C2 lateral mass. Preoperative lateral X-ray also revealed an atlanto-dens interval of 4.39mm and a C1 canal anterior-posterior diameter of 20.20mm. Preoperative magnetic resonance imaging (MRI) and computed tomography showed fractures of the bilateral anterior arch and the left side posterior arch of C1, and injury to the transverse ligament. Although there was no cord compression or abnormal cord signal change, mild dural sac compression of the left lateral side was observed (Fig. 1).


Occipital neuralgia after occipital cervical fusion to treat an unstable jefferson fracture.

Kong SJ, Park JH, Roh SW - Korean J Spine (2012)

(A) Preoperative open mouth view, showing a 7.26 mm displacement of the left C1 lateral mass to the C2 lateral mass. (B) Preoperative lateral X-ray showing a 4.39 mm atlanto-dens interval and a C1 canal diameter of 20.20mm. (C) Preoperative T2-weighted midline magnetic resonance sagittal image showing an absence of cord compression. (D) Preoperative T2-weighted magnetic resonance axial image at C1-C2 level revealing a Jefferson fracture, injury to the transverse ligament, and dural compression of the left side fractured lamina.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4430563&req=5

Figure 1: (A) Preoperative open mouth view, showing a 7.26 mm displacement of the left C1 lateral mass to the C2 lateral mass. (B) Preoperative lateral X-ray showing a 4.39 mm atlanto-dens interval and a C1 canal diameter of 20.20mm. (C) Preoperative T2-weighted midline magnetic resonance sagittal image showing an absence of cord compression. (D) Preoperative T2-weighted magnetic resonance axial image at C1-C2 level revealing a Jefferson fracture, injury to the transverse ligament, and dural compression of the left side fractured lamina.
Mentions: A 70-year-old male was admitted to our center with a Jefferson fracture caused by a car accident. The patient reported neck pain with an intensity of 7-8 on a visual analog scale ranging from 0-10, without any neurological deficit other than combined injury. A preoperative open mouth view showed a 7.26mm lateral displacement of the C1 to the C2 lateral mass. Preoperative lateral X-ray also revealed an atlanto-dens interval of 4.39mm and a C1 canal anterior-posterior diameter of 20.20mm. Preoperative magnetic resonance imaging (MRI) and computed tomography showed fractures of the bilateral anterior arch and the left side posterior arch of C1, and injury to the transverse ligament. Although there was no cord compression or abnormal cord signal change, mild dural sac compression of the left lateral side was observed (Fig. 1).

Bottom Line: We performed bilateral C2 root decompression via a C1 laminectomy.After decompression, bilateral C2 root redundancy was identified by palpation.After decompression surgery, pain was reduced.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.

ABSTRACT
In this report we describe a patient with an unstable Jefferson fracture who was treated by occipitocervical fusion and later reported sustained postoperative occipital neuralgia. A 70-year-old male was admitted to our center with a Jefferson fracture induced by a car accident. Preoperative lateral X-ray revealed an atlanto-dens interval of 4.8mm and a C1 canal anterior-posterior diameter of 19.94mm. We performed fusion surgery from the occiput to C5 without decompression of C1. The patient reported sustained continuous pain throughout the following year despite strong analgesics. The pain dermatome was located mainly in the great occipital nerve territory and posterior neck. Magnetic resonance images revealed no evidence of cord compression, however a C1 lamina compressed dural sac and C2 root compression could not be excluded. We performed bilateral C2 root decompression via a C1 laminectomy. After decompression, bilateral C2 root redundancy was identified by palpation. After decompression surgery, pain was reduced. This case indicates that occipital neuralgia, suggesting the need for diagnostic block, should be considered in the differential diagnosis of patients with sustained occipital headache after occipitocervical fusion surgery.

No MeSH data available.


Related in: MedlinePlus