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C2 Nerve Root on Magnetic Resonance Imaging of Occipital Neuralgia 2014

Category General Spine Minkyung Yi Joon Woo Lee Jin S Yeom Jongyeal Kang Purpose The purpose of this study was to evaluate the feasibility of magnetic resonance imaging (MRI) for C1/2 neural foramen evaluation with a new grading system and to correlate the C1/2 neural foramen grade with occipital neuralgia (ON) Materials & Methods This study was approved by our institutional review board. The requirement for informed consent was waived. Among the registry of 124 patients who underwent C1/2 spinal surgery between July 2004 and May 2012 in our institute, we enrolled 109 patients who had information with regard to ON and a relevant preoperative cervical spine MR image. A total of 218 neural foramina were evaluated with our new C1/2 neural foramen grading system (Grade 0 to 3) using consensus reading by two experienced radiologists who were blinded to the clinical information. The relationship between the C1/2 grading system and ON was assessed using a chi-square test and Fisher’s exact test. Results All C1/2 neural foramina were delineated on T2 parasagittal images. Among 218 C1/2 neural foramina, Grade 0 was found in 51 foramina (23.4%), Grade 1 in 105 (48.2%), Grade 2 in 31 (14.2%), and Grade 3 in 31(14.2%). The Grade 2 group had the most frequent prevalence of ON (41.9%), followed by Grade 3 (32.3%), Grade 0 (29.4%), and Grade 1 (26.7%). However, the relationship between the grade and ON was not statistically relevant. Conclusion C1/2 neural foramina can be depicted on MRI. However, the relationship between the new grading system for C1/2 neural foramina and ON was not statistically relevant. References 1. Bogduk N. The anatomical basis for cervicogenic headache. J Manipulative Physiol Ther. 1992;15(1):67-70. 2. Alix ME, Bates DK. A proposed etiology of cervicogenic headache: the neurophysiologic basis and anatomic relationship between the dura mater and the rectus posterior capitis minor muscle. J Manipulative Physiol Ther. 1999;22(8):534-539. 3. Antonaci F, Ghirmai S, Bono G, Sandrini G, Nappi G. Cervicogenic headache: evaluation of the original diagnostic criteria. Cephalalgia. 2001;21(5):573-583. 4. Haldeman S, Dagenais S. Cervicogenic headaches: a critical review. Spine J. 2001;1(1):31-46. 5. Persson LC, Carlsson JY, Anderberg L. Headache in patients with cervical radiculopathy: a prospective study with selective nerve root blocks in 275 patients. Eur Spine J. 2007;16(7):953-959. 6. CR H, FH M. Role of the upper cervical roots in the production of pain in the head. Am J Surg. 1949;78(5):743-751. 7. Aprill C, Axinn M, Bogduk N. Occipital headaches stemming from the lateral atlanto‐axial (C1–2) joint. Cephalalgia. 2002;22(1):15-22. 8. Ehni G, Benner B. Occipital neuralgia and the C1-2 arthrosis syndrome. J Neurosurg. 1984;61(5):961-965. 9. Fukui S, Ohseto K, Shiotani M, Ohno K, Karasawa H, Naganuma Y, Yuda Y. Referred pain distribution of the cervical zygapophyseal joints and cervical dorsal rami. Pain. 1996;68(1):79-83. 10. Keith W. "Whiplash"-injury of the 2nd cervical ganglion and nerve. Can J Neurol Sci. 1986;13(2):133-137. 11. Lu J, Ebraheim NA. Anatomic considerations of C2 nerve root ganglion. Spine. 1998;23(6):649-652. 12. Star MJ, Curd JG, Thorne RP. Atlantoaxial lateral mass osteoarthritis: a frequently overlooked cause of severe occipitocervical pain. Spine. 1992;17(6):S71-S76. 13. Bogduk N. The anatomy of occipital neuralgia. Clin Exp Neurol. 1981;17:167-184. 14. Warwick R WP, eds. Gray’s Anatomy. 38 ed. London: Churchill Livingstone, 1995. 15. Bilge O. An anatomic and morphometric study of C2 nerve root ganglion and its corresponding foramen. Spine. 2004;29(5):495-499. 16. Pedersen N, Lichtenstein P, Svedberg P. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Headache Classification Committee of the International Headache Society. Cephalalgia. 1988;8(Suppl 7):61-64. 17. Bogduk N. Cervicogenic headache: anatomic basis and pathophysiologic mechanisms. Curr Pain Headache Rep. 2001;5(4):382-386. 18. Escolar J. The afferent connections of the 1st, 2nd and 3rd cervical nerves in the cat. An analysis by Marchi and Rasdolsky methods. J Comp Neurol. 1948;89(2):79-92. 19. Jansen J, Bardosi A, Hildebrandt J, Lücke A. Cervicogenic, hemicranial attacks associated with vascular irritation or compression of the cervical nerve root C2. Clinical manifestations and morphological findings. Pain. 1989;39(2):203-212. 20. Sjaastad O, Fredriksen T, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. The Cervicogenic Headache International Study Group. Headache. 1998;38(6):442-445. 21. Pfaffenrath V, Dandekar R, Pöllmann W. Cervicogenic headache‐the clinical picture, radiological findings and hypotheses on its pathophysiology. Headache. 1987;27(9):495-499. 22. Fredriksen TA, Fougner R, Tangerud Å, Sjaastad O. Cervicogenic headache. Radiological investigations concerning head/neck. Cephalalgia. 2002;9(2):139-146. 23. Coskun O, Ucler S, Karakurum B, Atasoy H, Yildirim T, Ozkan S. Inan LE. Magnetic resonance imaging of patients with cervicogenic headache. Cephalalgia. 2003;23(8):842-845. 24. Fish DE, Kobayashi HW, Chang TL, Pham Q. MRI prediction of therapeutic response to epidural steroid injection in patients with cervical radiculopathy. Am J Phys Med Rehabil. 2009;88(3):239-246. 25. Teresi L, Lufkin R, Reicher M, et al. Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging. Radiology. 1987;164(1):83-88. 26. Lee MJ, Cassinelli EH, Riew KD. Prevalence of cervical spine stenosisanatomic study in cadavers. J Bone Joint Surg Am. 2007;89(2):376-380. 27. Boden S, Davis D, Dina T, Patronas N, Wiesel S. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990;990:403-408.