Evaluating the Evidence: Is Neurolysis or Neurectomy a Better Treatment for Occipital Neuralgia?

Occipital neuralgia, a neuropathy of the occipital nerves, can cause significant pain and distress, resulting in a decrease in the patient's quality of life. Options for surgical treatment involve transection or decompression of the greater and lesser occipital nerves. Current evidence provides no clear consensus regarding one technique over the other. Here, we present a systematic review of the literature to potentially answer this question. Eligible studies compared neurolysis versus neurectomy for the treatment of occipital neuralgia after failure of conservative therapy. Our outcome of interest was resolution of symptoms. We performed a search of MEDLINE/PubMed and Ovid from inception to 2019. Eligible studies included the words "occipital neuralgia" and "surgery." All studies comparing neurolysis to neurectomy were included in the analysis. None of the studies identified were randomized control trials. Each study was evaluated by two independent researchers who assigned a level of evidence according to the American Association of Neurology (AAN) algorithm. Data extracted included mechanism of surgery (neurolysis or neurectomy), resolution of pain symptoms, and length of follow-up. Each study was level IV evidence. After reviewing the data, there was insufficient evidence to recommend one method of treatment over the other. This inconclusive result highlights the importance of a national registry to compare outcomes between the two treatment modalities.