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Journal club: C2 nerve root transection during C1 lateral mass screw fixation: does it affect functionality and quality of life?

I n this important and timely study, Dewan and colleagues have addressed the clinical implications of deliberate C2 nerve root transection during C1 lateral mass screw placement. This is a topic of controversy, and the study represents a welcomed contribution to the literature. The instability of the atlantoaxial osteoligamentous complex may result from a myriad of pathological conditions, and there are a commensurate number of options for C1-2 arthrodesis. Harms andMelcher published their technique of C1 lateral mass and C2 pedicle/pars screws with adjoining rods in 2001, which was amodification of the original technique described by Goel and Laheri. This approach has risen in popularity, owing to the superior fusion rates compared with older techniques that relied on the posterior osseous elements. Despite the advantages, the C2 nerve roots and surrounding venous plexus provide a unique anatomic hindrance to the insertion of the C1 lateral mass screws. Advocates for C2 nerve root transection cite improved visualization of the C1 lateral mass, direct access for safe decortication of the C1-2 joint, reduced surgical time, and less bleeding. Additionally, postoperative occipital neuralgia may ensue from intraoperative traction on the C2 nerve root or irritation from the abutting C1 screw. Conversely, sharp transection of the C2 nerve roots may actually lead to more pain and numbness in the distribution of the greater and lesser occipital nerves, leaving the controversy unresolved. ORIGINALITY OF THE WORK