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. 2025 Feb;34(2):707-718.
doi: 10.1007/s00586-024-08614-x. Epub 2025 Jan 10.

Trigeminal neuralgia as a presentation of high cervical stenosis: a systematic review of the literature

G Barbagli  1 , O Aglan  2 , A Hussein  2 , D Soto-Rubio  2 , N Pacheco-Barrios  2 , C Li  2 , A Al-Arfaj  2 , J Kelbert  2 , N Dholaria  2 , A Pico  2 , C M Deaver  2 , I Alhalal  2 , M Prim  2 , A A Baaj  2
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Trigeminal neuralgia as a presentation of high cervical stenosis: a systematic review of the literature

G Barbagli et al. Eur Spine J. 2025 Feb.

Abstract

Purpose: An atypical presentation of cervical spondylopathy (CS), trigeminal neuralgia (TN) is attributable to the extension of trigeminal nuclei into the spinal cord and is frequently overlooked, leading to limited discussion with patients regarding potential anterior cervical surgery. Our systematic review assesses the effectiveness of cervical surgery for concurrent trigeminal neuralgia in cases of cervical spondylopathy.

Methods: A systematic review exploring cases of trigeminal neuralgia related to cervical spondylopathy was conducted searching on PubMed, Scopus and Embase databases for article in English. The authors excluded literature reviews and paediatric studies. Abstracts from articles were initially screened, followed by a detailed review of full-text papers. We included studies that documented cases of trigeminal neuralgia unrelated to cranial pathologies in patients with cervical spondylopathy.

Results: Following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) protocol, 6 studies were included covering 30 patients (20 male, 10 female) with a mean age of 60.75 years and average symptom duration was 18 months. The most affected branches were V2 (41%) and V3 (49%), evenly distributed between left and right sides (55% vs 45%). Motor weakness (60%) and paresthesia (27%) were common non-trigeminal symptoms. The predominant compression levels were C2-C3 (38%) and C3-C4 (34%). After anterior cervical surgery (30% of patients), 100% experienced immediate resolution of trigeminal neuralgia, with no recrudescence at an average 7-month follow-up.

Conclusion: Besides common manifestations, high cervical stenosis can cause trigeminal neuralgia. This case report and systematic review confirms spinal decompression and fusion surgery may be effective in select cases. Surgeons should raise the possibility of cervical spine involvement when counseling patients with this disease.

Keywords: Atypical symptoms; Cervical decompression and fusion; Cervical spondylopathy; In-patient setting; Trigeminal neuralgia.

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Conflict of interest statement

Declarations. Conflict of interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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