Dr. Jho's C-2 Microdecompression for Occipital Neuralgia(A Novel Treatment)

Dr. Jho's C-2 Microdecompression for Occipital Neuralgia: A Novel Treatment for Occipital Neuralgia or Headache

Brief summary of Dr. Jho's C-2 microdecompression Instead of the conventional treatment of nerve-cutting, the C-2 nerve root along with the ganglion and postgangionic nerve are decompressed (released from compression by blood vessels) via a small skin incision. Unlike the conventional surgery of nerve sectioning, Dr. Jho's operation is physiological because he does not sacrifice the nerve. Dr. Jho's C2 decompression operation involves an approximately 2-cm skin incision at the juncture between the posterior head and neck, and decompression of C2 nerve root, ganglion and postganglionic nerve. Decompression of the C2 nerve root and ganglion means that the compression around the nerve root and ganglion (often caused by vascular compression) is eliminated. The operation is performed with the use of the operating microscope or an endoscope under general anesthesia. Surgery takes approximately two hours. Hospital stay is overnight. Although patients will be fully functional in daily routine activity immediately after surgery, their surgical recovery will take approximately 4 to 6 weeks

Facts About This Surgery

Is innovative because it incorporates a non-destructive philosophy for a poorly defined disorder
Often done in conjunction with a C-2 marcaine block which acts as a diagnostic test
Is based on the thought that this type of pain is not dissimilar to the pain that occurs in lower cervical nerve roots, thus the title C-2 radiculopathy
Is usually done on an overnight or short stay basis

Discussion

A person that suffers from neck and arm pain from a cervical herniated disc or bony spur is said to have cervical radiculopathy which means nerve pain. The nerves in the neck that come off of the spinal cord are not unlike electrical cables coming from a fuse box and that travel throughout the house. So it may be that a person that has sharp stabbing pains at the top of the neck and the base of the skull and that radiate into the head may be suffering from C-2 radiculopathy. Instead of radiating into the arm like with a C-6 radiculopathy, C-2 nerve compression causes pain to "shoot" into the head. This is often called "occipital neuralgia". So rather than performing destructive procedures such as cutting the nerve which leads to numbness, this new innovative procedure addresses the underlying pathophysiology and removes whatever may be pressing on the C-2 nerve root. Continuing with the fuse box analogy, rather than cutting the cable when there is an electrical problem somewhere in the house, C-2 microdecompression confronts the problem at the "fuse box". This procedure is indicated for patients with the aforementioned symptoms who also received temporary or partial relief from a C-2 marcaine block, which serves to help confirm diagnosis.

Images

An intraoperative photograph shows a decompressed C2 nerve root and ganglion during C2 microdecompression (C: spinal cord, G: C2 ganglion, R: C2 nerve root).

Reference

Jho HD: Occipital neurectomy and decompression. In Fessler RG, Sekhar LN (eds), Atlas of Neurosurgical Techniques (in press)

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