Awake Endoscopic Radiofrequency Ablation for Lateral Atlantoaxial Joint Pain

Area of Science:

• Pain Management
• Minimally Invasive Procedures
• Diagnostic Imaging

Background:

• Chronic pain from the lateral atlantoaxial (C1-C2) joint presents treatment challenges.
• Conventional radiofrequency ablation (RFA) lacks direct visualization, leading to variable outcomes.
• Intractable occipital and neck pain often requires advanced therapeutic approaches.

Purpose of the Study:

• To introduce awake endoscopic radiofrequency ablation (ERFA) as a novel treatment for C1-C2 joint pain.
• To evaluate the efficacy of ERFA combined with SPECT/CT imaging for precise pain management.
• To present a case study demonstrating the benefits of this combined approach.

Main Methods:

• Utilized Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) for precise diagnosis of the pain generator.
• Performed awake endoscopic radiofrequency ablation (ERFA) targeting C1-C2 and C2-C3 facet joints.
• Employed direct endoscopic visualization and real-time patient feedback during the ablation procedure.

Main Results:

• SPECT/CT accurately identified active inflammation in the left C1-C2 facet joint.
• Awake ERFA provided direct visualization and precise denervation of the target facet joints.
• The patient experienced immediate 80% pain relief post-procedure.

Conclusions:

• The combination of SPECT/CT and awake ERFA is a promising modality for managing C1-C2 joint pain.
• ERFA offers precise, visually-confirmed nerve denervation, potentially improving long-term outcomes.
• This minimally invasive approach provides effective and durable relief for refractory neck pain.