Treatment Delay From Onset of Occipital Neuralgia Symptoms to Treatment with Nerve Decompression Surgery
Merel Helene Josephine Hazewinkel, MD1, Katya Remy, MD2, Grant G. Black, BA1, Sierra Tseng, student2, Paul G Mathew, MD2, Anna Schoenbrunner, MD3, Jeffrey Janis, MD3, William G., Jr. Austen, MD2 and Lisa Gfrerer, MD, PhD1, 1Weill Cornell Medicine, New York City, NY, 2Harvard Medical School, Boston, MA, 3The Ohio State University Wexner Medical Center, Columbus, OH
Introduction. In patients diagnosed with occipital neuralgia refractory to optimal medical management, surgical decompression has been shown to be an effective treatment option. However, nerve decompression surgery is not considered as part of the occipital neuralgia therapeutic algorithm. The aim of this study was to a) evaluate the time between onset of occipital neuralgia symptoms and nerve decompression surgery, b) perform a cost comparison analysis between surgical and non-surgical treatment of occipital neuralgia and c) report postoperative results of nerve decompression surgery for occipital neuralgia.
Materials & Methods. 1112 subjects who underwent screening for nerve decompression surgery between September 2012 and November 2022 were screened for a diagnosis of occipital neuralgia. 367 (33%) patients met the inclusion criteria. Demographic information, timing of occipital neuralgia symptom onset, and preoperative/postoperative pain characteristics were prospectively collected. Healthcare utilization and costs were calculated for the period between onset of occipital neuralgia symptoms to surgery.
Results. After screening, 226 (73%) patients underwent occipital nerve decompression. The average time between onset of occipital neuralgia and nerve decompression surgery was 19 years (7.1-32). The median number of pain days per month decreased by 17 days (0-26, 57%) (p<0.001), the median pain intensity decreased by 4 (2-8, 44%) (p<0.001) and median pain duration in hours was reduced by 12 hours (2-23, 50%) (p<0.001). The annual mean cost of non-surgical occipital neuralgia treatment was $14,209.88 ($4,994.70-$23,425.06) per patient. The mean cost during the 19-year timeframe prior to surgery was $269,987.695 ($94,899.22-$445,076.17), while the mean cost of occipital nerve decompression surgery was $12,000.00.
Conclusions. The results of this study demonstrate that nerve decompression surgery is an effective treatment for patients with occipital neuralgia. Therefore, nerve decompression surgery should be considered earlier in the treatment course of occipital neuralgia to prevent patient morbidity, and reduce healthcare costs.
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