C2 Nerve Dysfunction Associated with C1 Lateral Mass Screw Fixation

The C-1 lateral mass screw technique is widely used for atlantoaxial fixation. However, C-2 nerve dysfunction may occur as a complication of this procedure, compromising the quality of life of affected patients. This is a review of the topic of C-2 nerve dysfunction associated with C-1 lateral mass screw fixation and related research developments. The C-2 nerve root is located in the space bordered superiorly by the posterior arch of C-1, inferiorly by the C-2 lamina, anteriorly by the lateral atlantoaxial joint capsule, and posteriorly by the anterior edge of the ligamentum flavum. Some surgeons suggest cutting the C-2 nerve root during C-1 lateral mass screw placement, whereas others prefer to preserve it. The incidence, clinical manifestations, causes, management, and prevention of C-2 nerve dysfunction associated with C-1 lateral mass screw fixation are reviewed. Sacrifice of the C-2 nerve root carries a high risk of postoperative numbness, whereas postoperative nerve dysfunction can occur when it has been preserved. Many surgeons have been working hard on minimizing the risk of postoperative C-2 nerve dysfunction associated with C-1 lateral mass screw fixation.