Lesser Occipital Nerve Decompression through a Single Vertical Midline Incision Reduces Reoperation Rates.

Abstract

Background: Nerve decompression surgery for occipital neuralgia of the lesser occipital nerve (LON) is often performed in combination with treatment of the greater occipital nerve (GON) and the third occipital nerve. The traditional surgical approach of combined GON/LON decompression requires multiple separate incisions. This study describes a single vertical midline incision approach and reports on the postoperative outcomes.

Methods: Among 1713 patients who were screened for nerve decompression surgery between 2011 and 2023, those who underwent combined GON/LON decompression for treatment of occipital neuralgia were identified retrospectively. Patients who underwent the single vertical midline incision approach were compared with those who underwent the separate incision approach. Outcomes included postoperative complications; LON reoperation; pain frequency (days per month), intensity (scale, 0 to 10), and duration (hours); and Migraine Head Index at final follow-up.

Results: A total of 124 patients underwent 184 combined GON/LON operations. LON decompression was performed through a midline incision in 91 patients (73.4%) and through a separate incision in 33 patients (26.6%). LON reoperation rates for pain recurrence were higher in the separate incision group as compared with the midline incision group (15.2% versus 4.4%; P < 0.05). At a median follow-up of 17.9 months after the last intervention, reductions in pain frequency, intensity, duration, and Migraine Head Index were comparable between both techniques ( P > 0.05). Postoperative complications were not significantly different between both groups ( P > 0.05).

Conclusion: During combined GON/LON surgery, approaching the LON through the midline incision is feasible and allows for safe and effective LON decompression or neurectomy, with lower reoperation rates for recurrent pain.

Clinical question/level of evidence: Therapeutic, III.