• The Korean Journal of Pain
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• v.14 no.2
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• pp.193-198
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• 2001

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 $60^{\circ}C$ to $65^{\circ}C$ 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.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.200-205
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• 1996

Radiofrequency thermocoagulation(RF) techniques are safe and effective methods as compared to neurodestructive procedure. Other advantages are: ability to perform RF lesions under local or sedative anesthesia, rapid recovery period, low incidence of morbidity and mortality, ability to repeat RF lesions, and leaves no significant scarring. We performed C2 ganglionotomy by RF lesion generator on a patient, suffering post-traumatic occipital neuralgia, as the patient did not respond to conservative therapies such as: trigger point injection, TENS, cryotherapy and stretch, occipital nerve block, C2 ganglion block. Prognostic nerve block was performed usng local anesthetics. Excellent effect was conformed before C2 ganglionotomy. This procedure was performed under fluoroscopy. Type RCK-2A Rosomoff Cordotomy kit was used to stabilize the head and neck. Postoperatively, the patient was free of occipital pain and head motions no longer triggered pain. To date, the patient remains symptom free except for some cervical discomfort.