SURGICAL TREATMENT OF ARNOLD’S NEURALIGA: A SERIES OF EIGHT CASES

Abstract

Purpose: The long Arnold nerve can be compressed at several sites. We analysed retrospectively eight patients who underwent surgery for Arnold’s neuralgia between January 1998 and June 2000. The purpose of our analysis was to determine the results of the neurolysis technique.

Material and methods: There were seven women and one man, mean age 52 years. Pain had progressed for more than one year (mean 3.5 years) and all patients had participated in long rehabilitation programmes. All had had at least one radioguided posterior injection at the C1–C2 level. Bilateral neurolysis was performed for patients with bilateral pain. The same surgical technique was used for all patients: desinsertion of the inferior oblique muscle from the lateral aspect of C2 and neurolysis of the posterior branch of C2 to the lower border of the inferior oblique muscle. When needed because of major osteoarthritis, C1–C2 fusion was achieved by posterior lacing.

Results: There were no per or postoperative complications. Neuralgia improved in all patients (70/100 to 20/100 on visual analogue scale). Pain relief was considerable for one female patient who had associated C1–C2 osteoarthritis. One patient complained of posterior joint pain at last follow-up. an anatomic cause of the compression was identified in three cases: osteophyte on the posterior part of the C1-C2 articulation, hypertrophy of the periradicular venous plexus, and passage of the Arnold nerve within the inferior oblique muscle with compression in a fibromuscular sheath.

Discussion: Several methods have been proposed to relieve Arnold’s neuralgia. Rehabilitation exercises and injections should, in our opinion, be attempted first. The Sturniolo procedure (unique desinsertion of the inferior oblique muscle) would be insufficient. We prefer to associate neurolysis at the C2 level because of the frequently associated anatomic anomalies.

Conclusion: Different sites can be involved in the compression of the Arnold nerve, warranting associated neurolysis.