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. 2024 Mar 1;25(3):203-210.
doi: 10.1093/pm/pnad153.

Athrodesis of the lateral atlanto-axial joint for the relief of neck pain and cervicogenic headache

Richard D Ferch  1 , Tyson Zhang  1 , Nikolai Bogduk  2
Affiliations

Athrodesis of the lateral atlanto-axial joint for the relief of neck pain and cervicogenic headache

Richard D Ferch et al. Pain Med. .

Abstract

Background: Osteoarthrosis of the lateral atlanto-axial joint (LAAJ) may be a cause of upper neck pain and headache. Intra-articular injection of steroids may provide only short-lasting relief. For intractable pain, arthrodesis of the joint might be considered.

Objective: To determine the success rates of arthrodesis of the lateral atlanto-axial joint for relieving neck pain and disability.

Design: Practice audit.

Setting: Private practice of senior author.

Subjects: Prospective series of 23 consecutive patients.

Methods: Outcomes were measured using a numerical rating scale for neck pain, and the Neck Disability Index for disability. Success rates were calculated for various degrees of improvement of neck pain at long-term follow-up (8-40 months), and for achieving various combinations of improvement of both neck pain and disability.

Results: Complete relief of pain was achieved in 40% of patients, with a further 40% achieving at least 50% relief. At long-term follow-up, 30% of patients had no neck pain and no disability, and a further 25% had only minimal pain, minimal disability, or both.

Conclusions: The present study did not corroborate earlier studies that claimed outstanding outcomes for arthrodesis of the LAAJ, but its outcomes are consonant with more recent studies that provided transparent outcome data. These studies provide Pain Physicians with empirical data on success rates and outcomes, upon which they can base their consideration of referral for arthrodesis.

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Figures

Figure 1.
Figure 1.
Lateral radiograph of cervical spine showing the polyaxial screw and rod construct used for arthrodesis of the lateral atlanto-axial joint.
Figure 2.
Figure 2.
Lateral computerized tomography scan of cervical spine showing bridging of bone across the lateral atlanto-axial joint after arthrodesis.
Figure 3.
Figure 3.
Histograms of the scores for neck pain and neck disability at inception and at follow-up, of 20 patients treated by arthrodesis of the lateral atlanto-axial joint.
Figure 4.
Figure 4.
The histories of individual patients treated by arthrodesis of the lateral atlanto-axial joint. Each line represents a patient. Each line starts in the cell that represents the combined scores of that patient for neck pain and neck disability and ends in the cell that represents their final combined scores. For clarity of display, the patients have been depicted separately in 4 groups: Those with impressive improvements, those with substantial improvements, those with minor improvements, and the one patient who became worse.
See this image and copyright information in PMC

References

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