Korean J Spine.  2012 Dec;9(4):358-361. 10.14245/kjs.2012.9.4.358.

Occipital Neuralgia after Occipital Cervical Fusion to Treat an Unstable Jefferson Fracture

• Kong SJ
• Park JH
• Roh SW

• KMID: 2288510
• DOI: http://doi.org/10.14245/kjs.2012.9.4.358

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.

Keyword

Spinal fracture; Cervical atlas; Nerve root compression

MeSH Terms

Analgesics
Cervical Atlas
Decompression
Diagnosis, Differential
Headache
Humans
Laminectomy
Magnetic Resonance Spectroscopy
Male
Neck
Neuralgia
Palpation
Radiculopathy
Spinal Fractures
Analgesics