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European Spine Journal

, Volume 26, Issue 4, pp 1073–1081 | Cite as

C2 spondylotic radiculopathy: the nerve root impingement mechanism investigated by para-sagittal CT/MRI, dynamic rotational CT, intraoperative microscopic findings, and treated by microscopic posterior foraminotomy

  • Yasushi FujiwaraEmail author
  • Bunichiro Izumi
  • Masami Fujiwara
  • Kazuyoshi Nakanishi
  • Nobuhiro Tanaka
  • Nobuo Adachi
  • Hideki Manabe
Original Article

Abstract

Purpose

C2 radiculopathy is known to cause occipito-cervical pain, but their pathology is unclear because of its rarity and unique anatomy. In this paper, we investigated the mechanism of C2 radiculopathy that underwent microscopic cervical foraminotomies (MCF).

Methods

Three cases with C2 radiculopathy treated by MCF were investigated retrospectively. The mean follow-up period was 24 months. Pre-operative symptoms, imaging studies including para-sagittal CT and MRI, rotational dynamic CT, and intraoperative findings were investigated.

Results

There were 1 male and 2 females. The age of patients were ranged from 50 to 79 years. All cases had intractable occipito-cervical pain elicited by the cervical rotation. C2 nerve root block was temporally effective. There was unilateral spondylosis in symptomatic side without obvious atlatoaxial instability. Para-sagittal MRI and CT showed severe foraminal stenosis at C1–C2 due to the bony spur derived from the lateral atlanto-axial joints. In one case, dynamic rotational CT showed that the symptomatic foramen became narrower on rotational position. MCF was performed in all cases, and the C2 nerve root was impinged between the inferior edge of the C1 posterior arch and bony spur from the C1–C2 joint. After surgery, occipito-cervical pain disappeared.

Conclusion

This study demonstrated that mechanical impingement of the C2 nerve root is one of the causes of occipito-cervical pain and it was successfully treated by microscopic resection of the inferior edge of the C1 posterior arch. Para-sagittal CT and MRI, rotational dynamic CT, and nerve root block were effective for diagnosis.

Keywords

Occipital neuralgia Cervicogenic headache Microscopic surgery Foraminotomy Radiculopathy 

Notes

Acknowledgments

We appreciate Mr. Vincent John Hykel for his devoted support.

Compliance with ethical standards

Conflict of interest

None.

Supplementary material

Supplementary material 1 (WMV 121381 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Yasushi Fujiwara
    • 1
    Email author
  • Bunichiro Izumi
    • 1
  • Masami Fujiwara
    • 2
  • Kazuyoshi Nakanishi
    • 3
  • Nobuhiro Tanaka
    • 3
  • Nobuo Adachi
    • 3
  • Hideki Manabe
    • 1
  1. 1.Department of Orthopedic SurgeryHiroshima City Asa Citizens HospitalHiroshimaJapan
  2. 2.Department of Orthopedic SurgerySada HospitalFukuokaJapan
  3. 3.Department of Orthopaedic Surgery, Institute of Biomedical & Health SciencesHiroshima UniversityHiroshimaJapan

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