The efficacy of C1/2 arthrodesis with C2 root resection at symptomatic side for occipital neuralgia from atlantoaxial osteoarthritis

This article aimed to assess the efficacy of surgical treatments, particularly arthrodesis with C2 nerve transection, in patients with atlantoaxial osteoarthritis (AAOA). Data of patients with AAOA who underwent surgical treatment between January 2020 and November 2023 were retrospectively collected. Of 11 patients with AAOA, nine underwent fusion surgery, and two underwent decompression surgery. C2 root transection on the symptomatic side was performed in all fusion cases. C2 root transection was not performed during decompression. All patients experienced immediate and persistent pain relief after surgery. Four patients who underwent fusion surgery reported a complete disappearance of pain. Four patients who underwent fusion surgery reported some numbness of the scalp, but it did not affect the quality of daily activities or cause significant discomfort. One patient who underwent decompression surgery reported residual tingling sensation and hyperesthesia of the scalp. We concluded that C1-2 fusion surgery is an excellent surgical treatment option and should be primarily considered for patients with refractory AAOA. C2 root transection on the symptomatic side can completely alleviate pain at the expense of minor scalp anesthesia. Decompressive-only surgery is not recommended but can be considered in strictly selected patients.