RF of the Atlanto-axial joint

[pmrrulez]

Hey guys,

I have a patient that came to me with pain over the right atlantoaxial joint. She has had severe headaches and pain in the base of the neck for the last 3 years. She has had multiple procedures including occipital nerve blocks and cervical facet RFA from C2 to C5 and TON with no relief of her pain (different doctor). She has actually had that performed twice over the last 3 years even though the blocks also provided no relief. I performed a right atlantoaxial joint injection with approximately 1 month of 100% relief of her pain, then gradually returned over the following month. This the first time that she has had pain relief.

So, my thoughts are repeat the injection vs. potential RF. I have never done an RF of the AA, so I would likely refer it out, but I was just curious if anybody does this and if so what is the technique used.

Thanks!

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[bedrock]

Hey guys,

I have a patient that came to me with pain over the right atlantoaxial joint. She has had severe headaches and pain in the base of the neck for the last 3 years. She has had multiple procedures including occipital nerve blocks and cervical facet RFA from C2 to C5 and TON with no relief of her pain (different doctor). She has actually had that performed twice over the last 3 years even though the blocks also provided no relief. I performed a right atlantoaxial joint injection with approximately 1 month of 100% relief of her pain, then gradually returned over the following month. This the first time that she has had pain relief.

So, my thoughts are repeat the injection vs. potential RF. I have never done an RF of the AA, so I would likely refer it out, but I was just curious if anybody does this and if so what is the technique used.

Thanks!

Repeat the injection. RF of C1-C2 is risky , incomplete relief if it works at all, and very few people do it in the entire country. Way Yin in Seattle is one.

If excellent but brief relief after a second injection, then referral for C1-C2 fusion is also reasonable.

 

[clubdeac]

I'm curious as to how one would do this. bedrock you know?

 

[Ligament]

I'm curious as to how one would do this. bedrock you know?

Way Yin published the technique. I'm pretty sure there is only one or two pubs on the whole topic.

 

[bedrock]

Way Yin published the technique. I'm pretty sure there is only one or two pubs on the whole topic.

Way Yin is the master at this and I would consult his papers. It's too complex to explain here.
Personally, I would never attempt C1-C2 RF due to the risk and only partial relief after the risk.
Paul Dreyfuss doesn't even offer this procedure as far as I know, which says a lot.

 

[emd123]

I can't even find this in the new ISIS guidelines at all. They talk about c1/c2 joint injection (page 308, second ed. "C1/c2 blocks are not easy to perform and carry risks greater than other cervical joint blocks") but no mention of c1/c2 RF that I can find.

I interpret that as "stay away from c1/c2."

 

[Pacman27]

Do we know the innervation to the joint ?

I will look for the article as well. But my attending in fellowship stated that innervation is not completely understood and there maybe innervation from the anterior aspect as well

 

[lobelsteve]

Ive done c2 and ton. Not trying other stuff.

 

[Pacman27]

Ive done c2 and ton. Not trying other stuff.

Thanks for the article. My attending would mention the ventral gutter block, but never saw a good reason to try it

 

[Aether2000]

You will never find this in ISIS guidelines since it is way way (no pun intended) off the beaten path and is not standard therapy. The variability of the C1 is a huge problem and the use of RF so close to the cord (not to mention the spine itself) is profoundly hazardous. Would strongly recommend against trying to do a RF of the phantom C1.