Presentations

Abstract

Introduction:

Occipital neuralgia (ON) is characterized by severe pain originating from an occipital nerve. For patients that fail conservative and minimally invasive therapy, there are several surgical approaches to manage ON. Currently, there is little support in the literature for one surgery over another, and predictors of patient response are not standardized. We conducted a systematic review and meta-analysis to discuss the efficacy of two commonly used surgical interventions - subcutaneous nerve stimulator implantation and surgical decompression.

Methods:

PubMed, Ovid(Medline) and Web-of-Science were searched following PRISMA guidelines to include studies describing nerve stimulation or surgical decompression in the management of occipital neuralgia. A total of 158 references were screened for relevance. Only studies that published discrete patient information were included. Demographic data and outcomes were assessed. Chi-square tests and analysis of variance were used to identify any significant differences (p<0.05) between the two procedures.

Results:

Overall, 22 studies met inclusion criteria with a sample size of 74 patients. Of these, 13 underwent surgical nerve decompression (SD) and 61 had peripheral nerve stimulator implantation (NS). Patient ages ranged between 21-86 and symptom duration ranged between 6-132 months. Statistical significant differences between the two procedures were seen in patient age (SD: 38.9, NS: 49.9, p = 0.01), symptom duration (SD: 25 months, NS: 57 months, p = 0.021), 10-point pre-op pain score (SD: 7.2, NS: 8.3, p = 0.0497) and pre-op opioid use (SD: 0%, NS: 38%, p = 0.019). None of the differences in outcome variables such as change in pain score, complications or failures were statistically significant between the two treatment groups.

Conclusion:

We sought to compare treatment outcomes and patient demographics for the treatment of ON by surgical decompression vs nerve stimulation and found that while there were statistically significant differences between age and patient symptom history (duration, pain, opioid use) at presentation, the difference in outcomes between the two procedures was not statistically significant. Our study was limited by the inclusion of only studies that published discrete patient information in which metrics we collected were sparsely reported and unstandardized. A larger scale meta-analysis that included studies with pooled rates would provide higher statistical power and better discernment of difference in efficacy between the two treatments.