Virginia Research Day 2025

Medical Student Research Biomedical

08 Determining the Prevelance of the Neuroanatomical Sensory Elements of the C1 Spinal Level: A Systematic Review and Meta-Analysis

Antonio Balducci*; John Massie*; Dylan Carlson; Neal Patel; Aaron Beger, PhD Corresponding author: abalducci@vt.vcom.edu

Edward Via College of Osteopathic Medicine - Virginia Campus

Intractable occipital neuralgia is a debilitating neurological condition characterized by chronic burning, throbbing, or shooting pain in the area of the cranial base and scalp. Treatment may involve ablating the greater occipital nerve with the aim of anesthetizing the C2 dermatome. However, unresolved postoperative pain in a certain subset of patients suggests there may be supplemental sensory innervation from C1, despite being traditionally described as a pure motor nerve. Prior studies aimed at identifying the sensory neuroanatomical elements of C1, including dorsal roots, dorsal rootlets, or dorsal root ganglia have yielded disparate results

and are limited by small sample sizes. To gain a better understanding of the prevalence of sensory innervation provided by C1, a systematic review was conducted by searching MEDLINE, Pubmed, and Science Direct databases, as well as six anatomy specific journals ( n =434). Systematic Review Accelerator software was used to remove duplicates ( n =137), exclude articles through screening of abstracts and full-text review ( n =287), and find additional articles to add via citation mining (n=3), yielding a total of 13 articles for inclusion. Inclusion criteria included articles in English that provided data on the prevalence of dorsal roots, dorsal rootlets, or

dorsal root ganglia at the C1 spinal level in human subjects. Case studies, review articles, and animal studies were excluded. No date perimeters were employed. Data extraction revealed sensory elements of the C1 spinal level, including dorsal rootlets, dorsal roots, or dorsal root ganglia, were identified in 364/765 specimens (47.58%). This prevalence rate should be considered during the clinical decision making process in the treatment of intractable occipital neuralgia. Future aims include performing suboccipital dissections on cadaveric specimens to further elucidate the prevalence of neuroanatomical sensory elements of the C1 spinal level.

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