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Postoperative occipital neuralgia in posterior upper cervical spine surgery: a systematic review

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Abstract

Postoperative occipital neuralgia (PON) after upper cervical spine surgery can cause significant morbidity and may be overlooked. The causes, presentation, diagnosis, management, prognosis, and prevention of PON were reviewed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. English-language studies and case reports published from inception to 2017 were retrieved. Data on surgical procedures, incidence, cause of PON, management, outcomes, and preventive technique were extracted. Sixteen articles, including 591 patients, were selected; 93% of the patients with PON underwent C1 lateral mass screw (C1LMS) fixation, with additional 7% who underwent occipitocervical fusion without C1 fixation. PON had an incidence that ranged from 1 to 35% and was transient in 34%, but persistent in 66%. Five articles explained the possible causes. The primary presentation was constant or paroxysmal burning pain located mainly in the occipital and upper neck area and partially extending to the vertical, retroauricular, retromandibular, and forehead zone. Treatment included medications, nerve block, revision surgery, and nerve stimulation. Two prospective studies compared the effect of C2 nerve root transection on PON. PON in upper cervical spine surgery is a debilitating complication and was most commonly encountered by patients undergoing C1LMS fixation. The etiology of PON is partially clear, and the pain could be persistent and hard to cure. Reducing the incidence of PON can be realized by improving technique. More high-quality prospective studies are needed to define the effect of C2 nerve root transection on PON.

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Abbreviations

C1LMS:

C1 lateral mass screw

MR:

magnetic resonance

ON:

occipital neuralgia

PON:

postoperative occipital neuralgia

PRISMA:

Preferred Reporting Items for Systematic Review and Meta-analysis

VAS:

visual analogue scale

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Funding

This study was funded by Chinese national natural science foundation (31370984).

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Authors and Affiliations

  1. Department of Orthopedics, West China Hospital, Sichuan University, Guoxuexiang, No. 37, Chengdu, 610041, Sichuan Province, People’s Republic of China

    Qing Guan, Fei Xing, Ye Long & Zhou Xiang

  2. Department of Orthopedics, The First People’s Hospital of Yibin, Yibin, Sichuan Province, People’s Republic of China

    Qing Guan

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  1. Qing Guan
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  2. Fei Xing
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Correspondence to Zhou Xiang.

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Ethical approval is not applicable as this is a systematic review.

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Guan, Q., Xing, F., Long, Y. et al. Postoperative occipital neuralgia in posterior upper cervical spine surgery: a systematic review. Neurosurg Rev 41, 779–785 (2018). https://doi.org/10.1007/s10143-017-0923-z

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  • DOI: https://doi.org/10.1007/s10143-017-0923-z

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