c1,c2 rhizotomy

[nvrsumr]

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I saw a patient today who came to me for a second opinion on a "bilateral C1,C2 rhizotomy". Guy has C2-C7 ant and post fusion. Pain with rotation to the left. No headaches. CT mild arthritic changes to bilat O-A and A-A joints.

My anatomy books do not reveal a C1 or C2 medial branch to dennervate. Offered him left A-A block with steroid. Google search brought up several foreign studies on intradural surgical rhizotomy of C1, C2 post rami for occipital neuralgia.

Is there a percutaneous rhizotomy of C1, C2 that is possible? Obviously the O-A, A-A joints are innervated....

Thanks.

 

[Tenesma]

i think any patient w/ C2-C7 anterior fusion is unlikely to get relief from any procedure you may end up doing...

 

[nvrsumr]

agreed but he's an accountant who works full time and on no meds(anymore)... Id like to try to help him

Plus Im mainly wondering about this bs procedure being offered across town

 

[Mister Mxyzptlk]

I think I heard about an approach to doing this but if there is one, it is not going to be done by me.

How about C1/2 facet injections or has that been done? Maybe a suboccipital stim?

 

[pmrmd]

I saw something about this being done at the WFCCF. They were just starting to do this I think last year, but I forget the guy's name.

 

[lobelsteve]

agreed but he's an accountant who works full time and on no meds(anymore)... Id like to try to help him

Plus Im mainly wondering about this bs procedure being offered across town

I've got the same guy but he owns his own company and has to work. Talked to his wife today. He hurts more than he will tell me and refuses rx treatments. Rf C3-7 and TON. All axial. Headache some better after rf. Now what?

 

[bedrock]

I've got the same guy but he owns his own company and has to work. Talked to his wife today. He hurts more than he will tell me and refuses rx treatments. Rf C3-7 and TON. All axial. Headache some better after rf. Now what?

Occipital stim trial-

 

[nvrsumr]

Thank you for your responses. If anyone has an article(pdf) Id love to see it. I sort of called bs to the patient on the procedure and now I feel bad. Obviously new and interesting procedures are being thought up and put into practice.

 

[stim4u]

Thank you for your responses. If anyone has an article(pdf) Id love to see it. I sort of called bs to the patient on the procedure and now I feel bad. Obviously new and interesting procedures are being thought up and put into practice.

the one C2 rhizotomy I performed, resulted in dizziness for weeks. I would stay away. and stay with C3-6 RFA's with GON blocks.

 

[bedrock]

Thank you for your responses. If anyone has an article(pdf) Id love to see it. I sort of called bs to the patient on the procedure and now I feel bad. Obviously new and interesting procedures are being thought up and put into practice.

C1-C2 nerve ablation can be done, but the anatomy is complex, no one approach eliminates the entire C1-C2 nerve supply, and risk is high. Still borders on being BS procedure unless you have extensive expertise with it, and not worth the risk in most patients.

 

[Jcm800]

separate note, maybe hijacking this thread...

what about C2 nerve root injections...anyone do these? NSG wants me to try one in a patient, i havent done this. Advise?

 

[nvrsumr]

no hijack interested as well

 

[Ligament]

Way Yin published (or mentioned) a way to RF the lateral AA joints. I'll see if I can find the reference. Might have been an ISIS journal or something. I am not aware of any method to RF the OA joint. I just put phenol in the OA joint when needed.

 

[Ligament]

Kidding on the phenol in OA joint.

 

[Ligament]

Here is some info. This answers all of your questions, including anatomy and RF technique to C1 and C2. Let me know if you do it. I've been considering asking Way Yin if I can drive up and watch him do some of these.

 

[nvrsumr]

Thanks Ligament. Will check out.

 

[NOSfan]

Have had success with C2 DRG PRF.
Do a forum search and you should pull it up. Also, some photos were included.

 

[clubdeac]

Have had success with C2 DRG PRF.
Do a forum search and you should pull it up. Also, some photos were included.

What are you doing C2 PRFA for? HA pain or neck pain. I've got a lady I want to try it on

 

[NOSfan]

What are you doing C2 PRFA for? HA pain or neck pain. I've got a lady I want to try it on

HA, sub-occipital, greater, lesser neuralgias. Occasionally, pain radiating from nucchal-ridge area to retro-orbital or even jaw pain. I have dentist that sends all of his recalcitrant 'TMJ' patients to me.