Reoperation Following Primary Greater Occipital Nerve Decompression Surgery: Incidence, Risk Factors and Outcomes
Katya Remy, MD1, Merel Helene Josephine Hazewinkel, MD2, Connor Mullen, MD3, Robert R Hagan, MD4, William G., Jr. Austen, MD5 and Lisa Gfrerer, MD, PhD2, 1Massachusetts General Hospital, Harvard University, Boston, MA, 2Weill Cornell Medicine, New York City, NY, 3Neuropax Clinic, St. Louis, MT, 4Neuropax, St. Louis, MT, 5Harvard Medical School, Boston, MA
Introduction: Nerve decompression surgery is an effective treatment for refractory occipital neuralgia (ON). However, a proportion of patients experience recurrence of pain and undergo reoperation. This study analyzes the incidence, risk factors, and outcomes of reoperation following primary greater occipital nerve (GON) decompression.
Methods: 215 patients who underwent 399 primary GON decompressions were prospectively enrolled. Data included patient demographics, surgical technique, reoperation rates and postoperative outcomes. Pain was evaluated in terms of frequency (days/month), duration (hours/day), intensity (scale 0-10), and migraine headache index (MHI). Bivariate analyses and univariable and multivariable logistic regression analysis were performed.
Results: 27 (6.8%) GON decompressions required reoperation with neurectomy at a median follow-up time of 15.5 months (IQR 9.8-40.5). Upon bivariate analysis, factors significantly associated with higher reoperation rates were pain frequency ≥20 days per month (p=0.0025), preoperative MHI ≥150 (p=0.0114), <60% relief of pain following administration of nerve block (p=0.0291), <24 hour nerve block duration (p=0.0379), a history of ED visit for headache since onset of ON (p=0.0311), a history of a cervical spine disorder on imaging that did not warrant surgical intervention (p<0.0001), previous cervical spine intervention (p=0.0237), previous radiofrequency ablation (RFA) (p=0.0351), any psychiatric disorder (p=0.0071), and depression (p=0.0229). Upon multivariable logistic regression, significance was maintained for patients with a history of cervical spine disorder (OR, 4.88; 95% 1.61-14.79; p=0.0051) and RFA (OR, 4.20; 95% CI, 1.45-15.2; p=0.0289). At 12 months postoperatively, patients who underwent reoperation achieved similar mean reduction in pain frequency, duration, intensity and MHI, as compared to patients who underwent only primary decompression (p>0.05).
Conclusion: Patients with ON who have a history of cervical spine disorders or RFA should be counseled that primary decompression has a higher risk of reintervention, but outcomes are ultimately comparable.
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