Patel Akash J, Gressot Loyola V, Boatey Jerome, Hwang Steven W, Brayton Alison, Jea Andrew
Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, 6621 Fannin Street, CCC 1230.01, 12th Floor, Houston, TX 77030, USA.
Childs Nerv Syst. 2013 Jan;29(1):93-7. doi: 10.1007/s00381-012-1899-1. Epub 2012 Sep 27.
Adult studies have shown that sectioning the C2 nerve root and ganglion may facilitate placement of C1 lateral mass screws and lead to decreased operative time and blood loss. We report the functional outcomes and complications following routine sectioning of the C2 nerve root and ganglion, which have not been reported in pediatric patients.
Fifteen consecutive pediatric patients underwent C1 lateral mass screw insertion and bilateral C2 nerve root and ganglion sectioning. Clinical and radiographic assessments were performed at follow-up. Numbness in the C2 distribution and/or occipital neuralgia, operative times, estimated blood loss (EBL), length of stay (LOS), and complications were recorded.
Average follow-up time was 35.7 months. Overall mean operative time was 250.5 min, LOS was 8.46 days, and EBL was 337 cc. When considering only atlantoaxial fusions, mean operative time was 180.7 min and EBL was 97.1 cc. There were no intraoperative complications, and no patient reported new onset occipital neuralgia or numbness in the C2 distribution that would interfere with daily living. Of the patients, 93 % achieved Lenke fusion grade A; one achieved Lenke fusion grade B.
Routine C2 nerve root sectioning and ganglionectomy enhanced surgical exposure of the C1 lateral mass and C1-2 facet joint, potentially maximizing fusion rate and minimizing intraoperative complications. This technique may yield favorable operative times, EBL, and LOS in children undergoing C1 lateral mass screw insertion without negatively affecting functional outcome.
成人研究表明，切断C2神经根和神经节可能有助于C1侧块螺钉的置入，并减少手术时间和出血量。我们报告了常规切断C2神经根和神经节后的功能结果及并发症，此前在儿科患者中尚未有相关报道。
连续15例儿科患者接受了C1侧块螺钉置入及双侧C2神经根和神经节切断术。随访时进行临床和影像学评估。记录C2分布区域的麻木和/或枕神经痛、手术时间、估计失血量（EBL）、住院时间（LOS）及并发症。
平均随访时间为35.7个月。总体平均手术时间为250.5分钟，LOS为8.46天，EBL为337毫升。仅考虑寰枢椎融合时，平均手术时间为180.7分钟，EBL为97.1毫升。术中无并发症，且无患者报告出现影响日常生活的新发枕神经痛或C2分布区域麻木。患者中，93%达到Lenke融合A级；1例达到Lenke融合B级。
常规切断C2神经根和神经节切除术可增强C1侧块和C1-2小关节的手术显露，可能使融合率最大化并减少术中并发症。该技术在接受C1侧块螺钉置入的儿童中可获得良好的手术时间、EBL和LOS，且对功能结果无负面影响。
