CT-Guided C2 Dorsal Root Ganglion Radiofrequency Ablation for the Treatment of Cervicogenic Headache: Case Series and Clinical Outcomes

Abstract

Cervicogenic headache is a secondary headache syndrome attributable to upper cervical spine pathology. Osteoarthritis of the lateral atlantoaxial joint with resultant C2 dorsal root ganglion irritation is an important and potentially treatable cause of cervicogenic headache. In this case series, we present 11 patients with cervicogenic headache who underwent C2 dorsal root ganglion thermal radiofrequency ablation. Radiologists should be familiar with this efficacious procedure and technical considerations to avoid complications.

FIG 1.

Sagittal STIR image (patient 11) of the cervical spine showing T2 hyperintense bone marrow edema (arrows) in the lateral atlantoaxial (C1–C2) articulation.

FIG 2.

Intraprocedural axial CT image (patient 10) showing placement of a 22-ga RFA cannula at the expected location of the C2 DRG. The needle tip lies just above the C2 pedicle. The vertebral artery is safely located lateral to the C2 vertebral body at this level (asterisk).

FIG 3.

Intraprocedural axial CT image (patient 8) showing contrast injection surrounding the left the C2 DRG (arrow).