Treatment of severe retromastoid pain secondary to C1-2 arthrosis by using cervical fusion

In this report the authors review their 5-year experience in the diagnosis and management of nine patients with severe retromastoid pain secondary to C 1-2 arthrosis. Patients with symptomatic joints unresponsive to nonoperative therapy underwent cervical fusion procedures.

The mean age of the patients was 71 years, and the onset of prior symptoms ranged from 6 months to 18 years. All patients suffered similar discrete nonneuropathic pain without radicular symptoms ipsilateral to the diseased facet joint. Four patients experienced relief from pain with the use of nonoperative therapy. Five patients continued to experience intractable pain and underwent C1-2 fusion. The follow-up period ranged from 6 to 26 months. The cervical fusion procedure was successful in treating the retromastoid pain in all patients. In patients who underwent surgery, complete relief of pain was demonstrated in four and significantly reduced in the fifth.

The authors have drawn several conclusions. First, C1-2 arthrosis has a rather unique presentation and is a potential cause of upper posterior neck and head pain predominantly in elderly patients. Second, nonoperative management significantly improved the pain in nearly half of their patients and should be the first line of treatment. Last, C1-2 fusion was successful in treating the pain in patients in whom nonoperative management had failed to resolve symptoms.