Referred Pain Due to Greater Occipital Nerve Entrapment as a Cause of Failed Cervical Spine Surgery Syndrome

This report discusses a case of failed cervical spine surgery syndrome attributed to referred pain from greater occipital nerve (GON) entrapment. Although occipital neuralgia is commonly recognized as a symptom of GON entrapment, this condition typically manifests as continuous aching, tightening, and pressure-like pain across the GON distribution. Pain from chronic suboccipital and neck discomfort due to GON entrapment is often accompanied by referred pain in the orofacial and submandibular neck areas, as well as in the upper extremity. A lack of understanding of referred pain from chronic suboccipital and neck issues associated with GON entrapment may lead to unnecessary spinal surgery for asymptomatic degenerative lesions of the cervical spine. The anatomical basis for pain referral to the facial trigeminal area from GON entrapment involves the convergence of nociceptive inflow from the high cervical C1-3 structures and the trigeminal orofacial area onto the dorsal horn of the cervical spinal cord (trigeminocervical complex [TCC]) from the C2 segment to the medullary dorsal horn (MDH). Persistent noxious input due to GON entrapment may induce sensitization and hypersensitivity in the second-order neurons in both the TCC and MDH in the caudal trigeminal nucleus and high cervical cord.