Radiofrequency C2 Ganglionotomy in Atlantoaxial Subluxation: Short Term Follow up

Shim, Jae Hang; Shim, Jae Chul

Abstract

BACKGROUND: Anterior atlantoaxial subluxation (AAS) is a frequent phenomenon in rheumatoid arthritis (RA). AAS compresses the C2 ganglion or nerve and is a cause of posterior neck pain or occipital headache.
METHODS
We selected RA patients that had developed posterior neck pain or occipital headache caused by AAS. AAS was diagnosed by an increase of ADI (atlantodental interval). A distance of 3 mm or more was considered significant. Patients with vertical subluxation or symptoms suggestive of myelopathy were excluded. Before C2 RF ganglionotomy, we proceeded with a C2 ganglion block or greater occipital nerve block used by local anesthetics. For C2 RF ganglionotomy, the patient was placed in the supine position on a fluoroscopic table. A 100 mm, 4 mm active tip electrode was chosen. Following sensory stimulation at 0.2 to 0.6 V, the lesion was performed at a temperature of 60degrees C to 65degrees C for 60 sec. We followed up the patient after 6 months later.
RESULTS
All cases were female and the average duration of RA was 8.5 years. The duration of posterior neck pain or occipital headache was 1-8 months. The average ADI was 4.2 mm and the McGregor index was 3.3 mm on the average. In all cases, the score on the 4 point Likert scale was 4 (pain free) during the follow-up period.
CONCLUSIONS
We found that the occipital headache or posterior neck pain caused by AAS in rheumatoid arthritis patients was alleviated over a short term follow up. C2 RF ganglionotomy is suggested as an effective palliative treatment for AAS in RA patients.