Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Spine (Phila Pa 1976). 2017 Sep 15;42(18):E1067-E1076. doi: 10.1097/BRS.0000000000002069.
Systematic review and meta-analysis.
To evaluate the clinical and functional outcomes of transection of the C2 roots during C1 lateral mass screw placement for atlantoaxial fixation.
Transection of the C2 nerve roots has been recommended during atlantoaxial fixation to facilitate C1 lateral mass screw placement and possibly reduce postoperative occipital neuralgia, although this practice remains controversial.
We searched MEDLINE, EMBASE, Web of Science, and the Cochrane Library for studies evaluating the outcomes of C1-2 fixation involving sacrifice of the C2 roots. We calculated transformed proportions with 95% confidence intervals (CI) for the outcomes of occipital neuralgia, numbness, bony fusion, and procedural morbidity. For studies comparing C2 transection with nerve sparing surgery, we performed meta-analyses for the outcomes of occipital neuralgia, occipital numbness, blood loss, and operative time.
Eight observational studies (N = 393) met eligibility criteria. The rate of postoperative occipital neuralgia among included studies was 0% to 25%; occipital numbness, 6.7% to100%; bony fusion, 96.7% to 100%; and procedural morbidity, 0% to 14.3%. Among comparative studies, C2 transection was associated with a higher rate of occipital numbness [odds ratio (OR) 178.6 (95% CI 26.6 to 1198.4)], lower blood loss [mean difference (MD) -195.3 mL (95% CI -317.7 to -72.8 mL)] and shorter operative times [MD -57.5 mins (95% CI -76.9 to -38.2 mins)] than when the C2 roots were spared. We found no difference in rates of occipital neuralgia [OR 1.44 (95% CI 0.45 to 4.68)].
Transection of the C2 nerve roots appears to be a viable, safe option when undertaking placement of C1 lateral mass screws. The procedure is associated with reduced operative duration and blood loss, increased rate of occipital numbness, and no change in the rate of occipital neuralgia. However, given the relatively low quality of evidence, prospective, controlled studies to evaluate this strategy are recommended.
N /A.
系统评价和荟萃分析。
评估在寰枢椎固定中切断 C2 神经根后行 C1 侧块螺钉固定的临床和功能结果。
在寰枢椎固定中切断 C2 神经根已被推荐用于促进 C1 侧块螺钉放置，并可能减少术后枕神经痛，尽管这种做法仍存在争议。
我们检索了 MEDLINE、EMBASE、Web of Science 和 Cochrane 图书馆，以评估涉及牺牲 C2 神经根的 C1-2 固定的结果。我们计算了转换比例和 95%置信区间（CI）的枕神经痛、麻木、骨融合和手术发病率的结果。对于比较 C2 切断与神经保留手术的研究，我们对枕神经痛、枕部麻木、失血量和手术时间的结果进行了荟萃分析。
八项观察性研究（N=393）符合入选标准。包括研究的术后枕神经痛发生率为 0%至 25%；枕部麻木发生率为 6.7%至 100%；骨融合率为 96.7%至 100%；手术发病率为 0%至 14.3%。在比较研究中，C2 切断与枕部麻木发生率较高相关[比值比（OR）178.6（95%置信区间 26.6 至 1198.4）]、较低的失血量[平均差值（MD）-195.3 ml（95%置信区间-317.7 至-72.8 ml）]和较短的手术时间[MD-57.5 min（95%置信区间-76.9 至-38.2 min）]，而保留 C2 神经根的情况则较低。我们发现枕神经痛的发生率没有差异[OR 1.44（95%置信区间 0.45 至 4.68）]。
在进行 C1 侧块螺钉固定时，切断 C2 神经根似乎是一种可行且安全的选择。该操作与手术时间缩短和失血量减少相关，枕部麻木发生率增加，枕神经痛发生率无变化。然而，鉴于证据质量相对较低，建议进行前瞻性、对照研究来评估这种策略。
N/A。
