Pain Relief after Cervical Ganglionectomy (C₂ and C₃) for the Treatment of Medically Intractable Occipital Neuralgia

Abstract

Occipital neuralgia (ON) presents a diagnostic challenge because of the wide variety of symptoms, surgical findings, and postsurgical outcomes. Surgical removal of the second (C₂) or third (C₃) cervical sensory dorsal root ganglion is an option to treat ON. The goal of this study was to evaluate the short-term and the long-term efficacy of these procedures for management of cervical and occipital neuropathic pain. Twenty patients (mean age 48.7 years) were identified who had undergone C₂ and/or C₃ ganglionectomies for intractable occipital pain and a retrospective chart review undertaken. Patients were interviewed regarding pain relief, pain relief duration, functional status, medication usage and procedure satisfaction, preoperatively, immediately postoperative, and at follow-up (mean 42.5 months). C₂, C₃ and consecutive ganglionectomies at both levels were performed on 4, 5, and 11 patients, respectively. All patients reported preoperative pain relief following cervical nerve blocks. Average visual analog scale scores were 9.4 preoperatively and 2.6 immediately after procedure. Ninety-five percent of patients reported short-term pain relief (<3 months). In 13 patients (65%), pain returned after an average of 12 months (C₂ ganglionectomy) and 8.4 months (C₃ ganglionectomy). Long-term results were excellent, moderate and poor in 20, 40 and 40% of patients, respectively. Cervical ganglionectomy offers relief to a majority of patients, immediately after procedure, but the effect is short lived. Nerve blocks are helpful in predicting short-term success, but a positive block result does not necessarily predict long-term benefit and therefore cannot justify surgery by itself. However, since 60% of patients report excellent-moderate results, cervical ganglionectomy continues to have a role in the treatment of intractable ON.

Outcomes of Fusion for Lateral Atlantoaxial Osteoarthritis: Meta-Analysis and Review of Literature

“…Five retrospective studies reported on 28 patients who had PAAF via Gallie (25), Brooks (2), or Halifax clamp (1) techniques. Twelve studies comprising 97 patients underwent transarticular screw fixation; one study of 23 patients was performed prospectively and the remainder were retrospective.…”

“…Narouze et al (35) performed intra-articular blocks that provided significant short-term relief in 81% of patients, but the effects diminished by 3 and 6 months following the procedure. atlantoaxial disease with intra-articular steroid injections, 10 of whom had inflammatory disorders (rheumatoid arthritis [9] or ankylosis spondylosis [1]) and 16 who had mechanical disorders (AAOA [12], trauma-related arthropathy [3], or occipital neuralgia [1]). Response rate, mean pain score reduction, and duration were significantly better in patients with inflammatory disorders (100% vs. 50%, 79% vs. 36%, and 17 vs. 2.2 months, respectively).…”

“…Surgical options that do not entail immobilization and fusion across the atlantoaxial joint include C2 rhizotomy and ganglionectomy. These treatments have been more extensively used in patients with occipital neuralgia, where most patients experience short-term relief but long-term outcomes vary (1,8,32,43).…”

“…Minimally invasive options that have demonstrated some effectiveness include C2 nerve blocks, dorsal rhizotomy, or C2 ganglionectomy (1,8,32,43). The long-term efficacy of these techniques has not been demonstrated and some patients will suffer from intractable neck pain.…”

Pulsed radiofrequency of the second cervical ganglion (C2) for the treatment of cervicogenic headache

“…Most uncommon treatments that involve radiofrequency cervical zygapophyseal joint neurotomy and C2 and or C3 ganglionectomies are destructive [10, 11]. Owing to the formation of neuromas, it is possible to cause subsequent hyperpathia and allodynia.…”