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Nikolai Bogduk - One of the best experts on this subject based on the ideXlab platform.

  • sonographic visualization and ultrasound guided block of the Third Occipital Nerve prospective for a new method to diagnose c2 c3 zygapophysial joint pain
    Anesthesiology, 2006
    Co-Authors: Urs Eichenberger, Nikolai Bogduk, Manfred Greher, S. Kapral, Peter Marhofer, Roland Wiest, Luca Remonda, Michele Curatolo
    Abstract:

    BACKGROUND: Chronic neck pain after whiplash injury is caused by cervical zygapophysial joints in 50% of patients. Diagnostic blocks of Nerves supplying the joints are performed using fluoroscopy. The authors' hypothesis was that the Third Occipital Nerve can be visualized and blocked with use of an ultrasound-guided technique. METHODS: In 14 volunteers, the authors placed a needle ultrasound-guided to the Third Occipital Nerve on both sides of the neck. They punctured caudal and perpendicular to the 14-MHz transducer. In 11 volunteers, 0.9 ml of either local anesthetic or normal saline was applied in a randomized, double-blind, crossover manner. Anesthesia was controlled in the corresponding skin area by pinprick and cold testing. The position of the needle was controlled by fluoroscopy. RESULTS: The Third Occipital Nerve could be visualized in all subjects and showed a median diameter of 2.0 mm. Anesthesia was missing after local anesthetic in only one case. There was neither anesthesia nor hyposensitivity after any of the saline injections. The C2-C3 joint, in a transversal plane visualized as a convex density, was identified correctly by ultrasound in 27 of 28 cases, and 23 needles were placed correctly into the target zone. CONCLUSIONS: The Third Occipital Nerve can be visualized and blocked with use of an ultrasound-guided technique. The needles were positioned accurately in 82% of cases as confirmed by fluoroscopy; the Nerve was blocked in 90% of cases. Because ultrasound is the only available technique today to visualize this Nerve, it seems to be a promising new method for block guidance instead of fluoroscopy.

  • Sonographic visualization and ultrasound-guided block of the Third Occipital Nerve: prospective for a new method to diagnose C2-C3 zygapophysial joint pain.
    Anesthesiology, 2006
    Co-Authors: Urs Eichenberger, Nikolai Bogduk, Manfred Greher, S. Kapral, Peter Marhofer, Roland Wiest, Luca Remonda, Michele Curatolo
    Abstract:

    Chronic neck pain after whiplash injury is caused by cervical zygapophysial joints in 50% of patients. Diagnostic blocks of Nerves supplying the joints are performed using fluoroscopy. The authors' hypothesis was that the Third Occipital Nerve can be visualized and blocked with use of an ultrasound-guided technique. In 14 volunteers, the authors placed a needle ultrasound-guided to the Third Occipital Nerve on both sides of the neck. They punctured caudal and perpendicular to the 14-MHz transducer. In 11 volunteers, 0.9 ml of either local anesthetic or normal saline was applied in a randomized, double-blind, crossover manner. Anesthesia was controlled in the corresponding skin area by pinprick and cold testing. The position of the needle was controlled by fluoroscopy. The Third Occipital Nerve could be visualized in all subjects and showed a median diameter of 2.0 mm. Anesthesia was missing after local anesthetic in only one case. There was neither anesthesia nor hyposensitivity after any of the saline injections. The C2-C3 joint, in a transversal plane visualized as a convex density, was identified correctly by ultrasound in 27 of 28 cases, and 23 needles were placed correctly into the target zone. The Third Occipital Nerve can be visualized and blocked with use of an ultrasound-guided technique. The needles were positioned accurately in 82% of cases as confirmed by fluoroscopy; the Nerve was blocked in 90% of cases. Because ultrasound is the only available technique today to visualize this Nerve, it seems to be a promising new method for block guidance instead of fluoroscopy.

  • Radiofrequency neurotomy for the treatment of Third Occipital headache
    Journal of neurology neurosurgery and psychiatry, 2003
    Co-Authors: Jayantilal Govind, W. King, B. Bailey, Nikolai Bogduk
    Abstract:

    Objective: To evaluate the efficacy of a revised technique of percutaneous radiofrequency neurotomy for Third Occipital headache. Methods: The revisions included using a large gauge electrode, ensuring minimum separation between the three electrode placements, and holding the electrode in place by hand. The revised technique was used to treat 51 Nerves in 49 patients diagnosed as suffering from Third Occipital headache on the basis of controlled diagnostic blocks of the Third Occipital Nerve. The criteria for successful outcome were complete relief of pain for at least 90 days associated with restoration of normal activities of daily living, and no use of drug treatment for the headache. Results: Of the 49 patients, 43 (88%) achieved a successful outcome. The median duration of relief in these patients was 297 days, with eight patients continuing to have ongoing relief. Fourteen patients underwent a repeat neurotomy to reinstate relief, with 12 (86%) achieving a successful outcome. The median duration of relief in these patients was 217 days, with six patients having ongoing relief. Side effects of the procedure were consistent with coagulation of the Third Occipital Nerve and consisted of slight ataxia, numbness, and temporary dysaesthesia. No side effects required intervention, and they were tolerated by the patients in exchange for the relief of headache. Conclusions: Use of the revised procedure greatly improved the rather low success rate previously encountered with Third Occipital neurotomy. Although the relief of headache is limited in duration, it is profound and can be reinstated by repeat neurotomy. No other form of treatment has been validated for this common form of headache.

  • Percutaneous radiofrequency neurotomy in the treatment of cervical zygapophysial joint pain: a caution.
    Neurosurgery, 1995
    Co-Authors: Susan M. Lord, Leslie Barnsley, Nikolai Bogduk
    Abstract:

    Percutaneous radiofrequency neurotomy has been used in the treatment of pain from the cervical zygapophysial joints, but the results have been modest and not compelling. Several factors might account for its apparent poor success rate, including inadequate patient selection, inaccurate surgical anatomy, and technical errors. In an effort to overcome these confounders, we used comparative local anesthetic blocks to preoperatively, definitively diagnose cervical zygapophysial joint pain and developed an amended operative technique based on formal anatomical studies. An audit was conducted of our experience with 19 patients to determine whether there was sufficient merit in the amended procedure to justify a randomized, double-blind, controlled trial. The duration of complete pain relief was the principal outcome measure. Side effects and complications were also monitored. Of the 10 patients who underwent Third Occipital neurotomy for the treatment of C2-C3 zygapophysial joint pain, only 4 obtained long-lasting relief. The other six patients reported an early return of their pain and constituted technical failures; the Third Occipital Nerve was inadequately coagulated and recovered in the immediate postoperative period. Of the 10 patients who underwent lower cervical medial branch neurotomy, 7 obtained complete pain relief for clinically useful periods and were able to resume their activities of daily living and employment. After procedures at all levels, a brief period of postoperative pain was experienced by the patients and ataxia was a side effect of Third Occipital neurotomy. There were no cases of postoperative infection or anesthesia dolorosa. Given the high technical failure rate of Third Occipital neurotomy, we recommend that this procedure be abandoned until the technical problems can be overcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Traci A. Purath - One of the best experts on this subject based on the ideXlab platform.

  • response of cervicogenic headaches and Occipital neuralgia to radiofrequency ablation of the c2 dorsal root ganglion and or Third Occipital Nerve
    Headache, 2014
    Co-Authors: John F. Hamer, Traci A. Purath
    Abstract:

    Objective This article investigates the degree and duration of pain relief from cervicogenic headaches or Occipital neuralgia following treatment with radiofrequency ablation of the C2 dorsal root ganglion and/or Third Occipital Nerves. It also addresses the procedure's complication rate and patient's willingness to repeat the procedure if severe symptoms recur. Methods This is a single-center retrospective observational study of 40 patients with refractory cervicogenic headaches and or Occipital neuralgia. Patients were all referred by a headache specialty clinic for evaluation for radiofrequency ablation of the C2 dorsal root ganglion and/or Third Occipital Nerves. After treatment, patients were followed for a minimum of 6 months to a year. Patient demographics and the results of radiofrequency ablation were recorded on the same day, after 3-4 days, and at 6 months to 1 year following treatment. Results Thirty-five percent of patients reported 100% pain relief and 70% reported 80% or greater pain relief. The mean duration of improvement is 22.35 weeks. Complication rate was 12-13%. 92.5% of patients reported they would undergo the procedure again if severe symptoms returned. Conclusions Radiofrequency ablation of the C2 dorsal root ganglion and/or Third Occipital Nerve can provide many months of greater than 50% pain relief in the vast majority of recipients with an expected length of symptom improvement of 5-6 months.

  • Response of cervicogenic headaches and Occipital neuralgia to radiofrequency ablation of the C2 dorsal root ganglion and/or Third Occipital Nerve.
    Headache, 2014
    Co-Authors: John F. Hamer, Traci A. Purath
    Abstract:

    Objective This article investigates the degree and duration of pain relief from cervicogenic headaches or Occipital neuralgia following treatment with radiofrequency ablation of the C2 dorsal root ganglion and/or Third Occipital Nerves. It also addresses the procedure's complication rate and patient's willingness to repeat the procedure if severe symptoms recur. Methods This is a single-center retrospective observational study of 40 patients with refractory cervicogenic headaches and or Occipital neuralgia. Patients were all referred by a headache specialty clinic for evaluation for radiofrequency ablation of the C2 dorsal root ganglion and/or Third Occipital Nerves. After treatment, patients were followed for a minimum of 6 months to a year. Patient demographics and the results of radiofrequency ablation were recorded on the same day, after 3-4 days, and at 6 months to 1 year following treatment. Results Thirty-five percent of patients reported 100% pain relief and 70% reported 80% or greater pain relief. The mean duration of improvement is 22.35 weeks. Complication rate was 12-13%. 92.5% of patients reported they would undergo the procedure again if severe symptoms returned. Conclusions Radiofrequency ablation of the C2 dorsal root ganglion and/or Third Occipital Nerve can provide many months of greater than 50% pain relief in the vast majority of recipients with an expected length of symptom improvement of 5-6 months.

Roderick J. Finlayson - One of the best experts on this subject based on the ideXlab platform.

  • Cervical Medial Branch and Third Occipital Nerve Blocks
    Ultrasound for Interventional Pain Management, 2019
    Co-Authors: John-paul B. Etheridge, Roderick J. Finlayson
    Abstract:

    Cervical medial branch blocks and Third Occipital Nerve blocks are commonly used in the diagnosis and treatment of chronic neck pain and headaches related to cervical facet joints. When used to perform these blocks, ultrasound guidance can offer several advantages compared to fluoroscopy, such as shorter performance times and the need for fewer needle passes. In this chapter, we provide a detailed technical review of the in-plane sonographic approach.

  • Anatomical Variations of the Vertebral Artery in the Upper Cervical Spine: Clinical Relevance for Procedures Targeting the C1/C2 and C2/C3 Joints
    Regional anesthesia and pain medicine, 2018
    Co-Authors: Maria Francisca Elgueta, De Q.h. Tran, Johanna Ortiz Jimenez, Nina Nan Wang, Almudena Pérez Lara, Jeffrey Chankowsky, Roshanak Charghi, Roderick J. Finlayson
    Abstract:

    Background and Objectives Accidental breach of the vertebral artery (VA) during the performance of cervical pain blocks can result in significant morbidity. Whereas anatomical variations have been described for the foraminal (V2) segment of the VA, those involving its V3 portion (between the C2 transverse process and dura) have not been investigated and may be of importance for procedures targeting the Third Occipital Nerve or the lateral atlantoaxial joint. Methods Five hundred computed tomography angiograms of the neck performed in patients older than 50 years for the management of cerebrovascular accident or cervical trauma (between January 2010 and May 2016) were retrospectively and independently reviewed by 2 neuroradiologists. Courses of the VA in relation to the lateral aspect of the C2/C3 joint and the posterior surface of the C1/C2 joint were examined. For the latter, any medial encroachment of the VA (or one of its branches) was noted. The presence of a VA loop between C1 and C2 and its distance from the upper border of the superior articular process (SAP) of C3 were also recorded. If the VA loop coursed posteriorly, its position in relation to 6 fields found on the lateral aspects of the articular pillars of C2 and C3 was tabulated. Results At the C1/C2 level, the VA coursed medially over the lateral quarter of the dorsal joint surface in 1% of subjects (0.6% and 0.4% on the left and right sides, respectively; P = 0.998). A VA loop originating between C1 and C2 was found to travel posteroinferiorly over the anterolateral aspect of the inferior articular pillar of C2 in 55.5% of patients on the left and 41.9% on the right side (P Conclusions The VA commonly travels adjacent to areas targeted by Third Occipital Nerve procedures and more rarely over the access point for lateral atlantoaxial joint injections. Modifications to existing techniques may reduce the risk of accidental VA breach.

  • Ultrasound-Guided Cervical Medial Branch Blocks: A Technical Review
    International Journal of Physical Medicine & Rehabilitation, 2016
    Co-Authors: Atikun Thonnagith, De Q.h. Tran, Maria Francisca Elgueta, Pornpan Chalermkitpanit, Roderick J. Finlayson
    Abstract:

    Cervical medial branch blocks are commonly performed for the diagnosis and treatment of chronic neck pain and headaches. Although fluoroscopy constitutes the imaging standard for these procedures, recent evidence suggests that ultrasound guidance (USG) can provide similar accuracy coupled with shorter performance times. Moreover the ability to visualize soft tissue structures allows the operator to detect and avoid blood vessels, thus reducing complications related to vascular breach. In this review article, we discussed the technical considerations and evidence supporting the use of USG for cervical medial branch and Third Occipital Nerve blocks.

  • A randomized comparison between ultrasound- and fluoroscopy-guided Third Occipital Nerve block.
    Regional anesthesia and pain medicine, 2013
    Co-Authors: Roderick J. Finlayson, John-paul B. Etheridge, Lucy Vieira, Gaurav Gupta, De Q.h. Tran
    Abstract:

    Background Third Occipital Nerve block (TONB) is commonly used in the diagnosis and treatment of upper neck pain and cervicogenic headaches. Although fluoroscopy is the current imaging standard for TONB, ultrasound (US) guidance offers a promising, radiation-free alternative. In this randomized, observer-blinded trial, we compared the 2 imaging modalities. Our research hypothesis was that US guidance would result in a shorter performance time. Methods Forty patients undergoing TONB were randomized to fluoroscopy or US guidance. A mixture of local anesthetic and radiographic contrast was injected in both groups. The primary outcome was performance time. Secondary outcomes included success rate, pain levels before and after block, area of sensory hypoesthesia, quality of the block (assessed by electrical perceptual threshold), and procedure-related complications. Results Ultrasound guidance was associated with a significantly shorter performance time (212.8 vs 396.5 seconds; P = 0.000) and fewer needle passes (2 vs 6; P = 0.000). Both imaging modalities, however, resulted in similar success rates (95%–100%). Furthermore, no intergroup differences were found in preblock and postblock pain scores. In both groups, TONB produced hypoesthesia that was most profound in the subOccipital region. In the fluoroscopy group, C2–C3 intra-articular spread of radiographic contrast and vascular breach were noted in 15% and 10% of patients, respectively. In contrast, no adverse events occurred with US guidance. Conclusions Fluoroscopy and US guidance provide similar success rates for TONB. However, ultrasonography is associated with improved efficiency (decreased performance time, fewer needle passes).

  • Cervical medial branch block: a novel technique using ultrasound guidance.
    Regional anesthesia and pain medicine, 2012
    Co-Authors: Roderick J. Finlayson, Gaurav Gupta, Mohammed Alhujairi, Shubada Dugani, De Q.h. Tran
    Abstract:

    Background Cervical medial branch blocks are commonly performed for the diagnosis and treatment of head, neck, and shoulder pain. Intermittent fluoroscopy is widely used for needle positioning and visualization of contrast distribution before medication injection. The purpose of this study was to examine the use of ultrasound as an alternative imaging technique to block the Third Occipital Nerve and the C3 to C6 medial branches. Methods The study involved 2 phases with a total of 53 patients. The purpose of phase 1 was to assess the reliability of needle positioning using an ultrasound target corresponding to the middle of the bony contour of the articular pillar. Twenty patients undergoing 46 cervical medial branch blocks between C3 and C6 were recruited, and the needle tip position was graded on a 3-point scale based on its proximity to the centroid on lateral radiograph. In phase 2, 50 patients undergoing 163 levels were recruited. Using ultrasound guidance, each of the targeted levels was injected with 0.3 mL of a 1:1 mixture of local anesthetic and contrast agent. A blinded assessor reviewed contrast distribution in the anteroposterior and lateral radiograph views. Results In phase 1, all needle tips were positioned on the articular pillars; furthermore, 80.1% were located in the middle 2 quarters of the latter. In phase 2, the contrast was found to cover the appropriate level in 94.5% of cases, and no complications were noted. The incidence of aberrant spread to adjacent levels (13.5%) was similar to that reported with fluoroscopy. Conclusions Ultrasound guidance offers a reliable alternative to fluoroscopy for Third Occipital Nerve and C3–C6 cervical medial branch blocks. Further studies are required to validate the clinical efficacy of our technique.

Urs Eichenberger - One of the best experts on this subject based on the ideXlab platform.

  • Accuracy of ultrasound-guided Nerve blocks of the cervical zygapophysial joints.
    Anesthesiology, 2012
    Co-Authors: Andreas Siegenthaler, Michele Curatolo, Sabine Mlekusch, Sven Trelle, Juerg Schliessbach, Urs Eichenberger
    Abstract:

    Cervical zygapophysial joint Nerve blocks typically are performed with fluoroscopic needle guidance. Descriptions of ultrasound-guided block of these Nerves are available, but only one small study compared ultrasound with fluoroscopy, and only for the Third Occipital Nerve. To evaluate the potential usefulness of ultrasound-guidance in clinical practice, studies that determine the accuracy of this technique using a validated control are essential. The aim of this study was to determine the accuracy of ultrasound-guided Nerve blocks of the cervical zygapophysial joints using fluoroscopy as control.

  • ultrasound anatomy of the Nerves supplying the cervical zygapophyseal joints an exploratory study
    Regional Anesthesia and Pain Medicine, 2011
    Co-Authors: Andreas Siegenthaler, Michele Curatolo, Juerg Schliessbach, Urs Eichenberger
    Abstract:

    Background and Objectives: Nerve blocks and radiofrequency neurotomy of the Nerves supplying the cervical zygapophyseal joints are validated tools for diagnosis and treatment of chronic neck pain, respectively. Unlike fluoroscopy, ultrasound may allow visualization of the target Nerves, thereby potentially improving diagnostic accuracy and therapeutic efficacy of the procedures. The aims of this exploratory study were to determine the ultrasound visibility of the target Nerves in chronic neck pain patients and to describe the variability of their course in relation to the fluoroscopically used bony landmarks. Methods: Fifty patients with chronic neck pain were studied. Sonographic visibility of the Nerves and the bony target of fluoroscopically guided blocks were determined. The craniocaudal distance between the Nerves and their corresponding fluoroscopic targets was measured. Results: Successful visualization of the Nerves varied from 96% for the Third Occipital Nerve to 84% for the medial branch of C6. The great exception was the medial branch of C7, which was visualized in 32%. The bony targets could be identified in all patients, with exception of C7, which was identified in 92%. The craniocaudal distance of each Nerve to the corresponding bony target varied, the upper limit of the range being 2.2 mm at C4, the lower limit 1.0 mm at C7. Conclusions: The medial branches and their relation to the fluoroscopically used bony targets were mostly visualized by ultrasound, with the exception of the medial branch of C7 and, to a lesser extent, the bony target of C7. The Nerve location may be distant from the fluoroscope9s target. These findings justify further studies to investigate the validity of ultrasound guided blocks for invasive diagnosis/treatment of cervical zygapophyseal joint pain.

  • Ultrasound-Guided Third Occipital Nerve and Cervical Medial Branch Nerve Blocks
    Atlas of Ultrasound-Guided Procedures in Interventional Pain Management, 2010
    Co-Authors: Andreas Siegenthaler, Urs Eichenberger
    Abstract:

    Cervical zygapophyseal (facet) joints are diarthrodial joints formed by the superior articular process of one cervical vertebra articulating with the inferior articular process of the vertebrae above at the level of the junction of the lamina and the pedicle. The angulations of the facet joints increases caudally, being about 45° to the transverse plane at the upper cervical level to assuming a more vertical position at the upper thoracic level. The superior articular process also faces more posteromedial at the upper cervical level, and this changes to more posterolateral at the lower cervical level, with C6 being the most common transition level [1, 2].

  • Ultrasound-guided Third Occipital Nerve and cervical medial branch Nerve blocks
    Techniques in Regional Anesthesia and Pain Management, 2009
    Co-Authors: Andreas Siegenthaler, Samer Narouze, Urs Eichenberger
    Abstract:

    Chronic neck pain following whiplash injury is caused by cervical zygapophysial joints in up to 50% of patients. Diagnostic blocks of Nerves supplying the joints are mandatory to diagnose zygapophysial joint pain and are usually done under fluoroscopic (or CT) control. Ultrasound (US) guidance may be a very useful alternative to block the Nerves supplying the cervical facet joints lower than C2. In contrast to fluoroscopy or CT, in most patients, the cervical medial branches can be visualized by US. One exception is the Nerve at the level of C7, where the superimposed layer of soft tissue does not allow visualizing this small Nerve in most patients. The needle tip can be advanced under direct view, and the local anesthetic can be injected close to the targeted Nerve. One important advantage of US is the direct visualization of the spread of the injected local anesthetic and therefore no need for contrast injection. If the Nerve is not reached by the injected local anesthetic in the first attempt, a minor adjustment of the needle tip position and a second injection can correct this.

  • Sonographic visualization and ultrasound-guided block of the Third Occipital Nerve: prospective for a new method to diagnose C2-C3 zygapophysial joint pain.
    Anesthesiology, 2006
    Co-Authors: Urs Eichenberger, Nikolai Bogduk, Manfred Greher, S. Kapral, Peter Marhofer, Roland Wiest, Luca Remonda, Michele Curatolo
    Abstract:

    Chronic neck pain after whiplash injury is caused by cervical zygapophysial joints in 50% of patients. Diagnostic blocks of Nerves supplying the joints are performed using fluoroscopy. The authors' hypothesis was that the Third Occipital Nerve can be visualized and blocked with use of an ultrasound-guided technique. In 14 volunteers, the authors placed a needle ultrasound-guided to the Third Occipital Nerve on both sides of the neck. They punctured caudal and perpendicular to the 14-MHz transducer. In 11 volunteers, 0.9 ml of either local anesthetic or normal saline was applied in a randomized, double-blind, crossover manner. Anesthesia was controlled in the corresponding skin area by pinprick and cold testing. The position of the needle was controlled by fluoroscopy. The Third Occipital Nerve could be visualized in all subjects and showed a median diameter of 2.0 mm. Anesthesia was missing after local anesthetic in only one case. There was neither anesthesia nor hyposensitivity after any of the saline injections. The C2-C3 joint, in a transversal plane visualized as a convex density, was identified correctly by ultrasound in 27 of 28 cases, and 23 needles were placed correctly into the target zone. The Third Occipital Nerve can be visualized and blocked with use of an ultrasound-guided technique. The needles were positioned accurately in 82% of cases as confirmed by fluoroscopy; the Nerve was blocked in 90% of cases. Because ultrasound is the only available technique today to visualize this Nerve, it seems to be a promising new method for block guidance instead of fluoroscopy.

Emad Zarief Kamel - One of the best experts on this subject based on the ideXlab platform.

  • THU0453 Third Occipital Nerve RADIO-FREQUENCY UNDER FLUOROSCOPIC GUIDANCE IN MANAGEMENT OF CERVICOGENIC HEADACHE IN RHEUMATOID ARTHRITIS
    Annals of the Rheumatic Diseases, 2020
    Co-Authors: A Alawamy, Manal Hassanien, E Talaat, Emad Zarief Kamel
    Abstract:

    Background:Rheumatoid arthritis is a common type of autoimmune arthritis characterized by chronic inflammation. Cervical spine is often affected specially in long lasting diseaseObjectives:Evaluate efficacy of Third Occipital Nerve Radiofrequency under fluoroscopic guidance to treat refractory cervicogenic headache in RA patients.Methods:The current study was revised and approved from the local ethical committee of Faculty of Medicine; Assiut University, then registered in the clinical trials under the number ofNCT03852355. Inclusion criteria included, Patients who fulfilled the American College of Rheumatology (ACR) (2010) criteria for RA and suffering from upper neck pain and/or headache due to bilateral 3rd Occipital Nerve involvement, excluding other local cervical spine pathologies was confirmed by MRI and previously failed conservative treatment for at least three months prior to enrollment. Sixty adult patients were randomly assigned to one of the two studied groups Group 1 (RF, n = 30), received bilateral Third Occipital Nerve Radiofrequency under fluoroscopic guidance or Group 2 (control group, n = 30), received oral prednisolone 10 mg/day. The two groups were then followed-up with neck disability index (NDI), nocturnal neck pain VAS score and headache score every two weeks for three months. Sleep disturbance, sleep disability index were reassessed six months post intervention. Post interventional assessment was done by pain physician who were kept blind to the grouping process.Results:Neck disability index (1ry outcome), Nocturnal pain VAS, and severity of headache showed significant differences during the whole post-interventional study period. The patients in RF group demonstrated significant improvement of pain in comparison to baseline value over the whole six months with p-value < 0.001 as regard to the fore-mentioned three parameters. On the other aspect, the control group patients showed significant improvement in comparison to its baseline value after the 2nd, 12th and 24th weeks only as follows: (0.001,0.003, 0.003 for the NDI) (p values of 0.02,0.01, 0.01 for the nocturnal pain VAS), (0.001 0.009, 0.005 for the headache VAS severity.Conclusion:Radiofrequency of 3rd Occipital Nerve is effective in treatment of refractory cervicogenic headache in RA.Disclosure of Interests: :None declared

  • thu0453 Third Occipital Nerve radio frequency under fluoroscopic guidance in management of cervicogenic headache in rheumatoid arthritis
    Annals of the Rheumatic Diseases, 2020
    Co-Authors: A Alawamy, Manal Hassanien, E Talaat, Emad Zarief Kamel
    Abstract:

    Background: Rheumatoid arthritis is a common type of autoimmune arthritis characterized by chronic inflammation. Cervical spine is often affected specially in long lasting disease Objectives: Evaluate efficacy of Third Occipital Nerve Radiofrequency under fluoroscopic guidance to treat refractory cervicogenic headache in RA patients. Methods: The current study was revised and approved from the local ethical committee of Faculty of Medicine; Assiut University, then registered in the clinical trials under the number of NCT03852355. Inclusion criteria included, Patients who fulfilled the American College of Rheumatology (ACR) (2010) criteria for RA and suffering from upper neck pain and/or headache due to bilateral 3rd Occipital Nerve involvement, excluding other local cervical spine pathologies was confirmed by MRI and previously failed conservative treatment for at least three months prior to enrollment. Sixty adult patients were randomly assigned to one of the two studied groups Group 1 (RF, n = 30), received bilateral Third Occipital Nerve Radiofrequency under fluoroscopic guidance or Group 2 (control group, n = 30), received oral prednisolone 10 mg/day. The two groups were then followed-up with neck disability index (NDI), nocturnal neck pain VAS score and headache score every two weeks for three months. Sleep disturbance, sleep disability index were reassessed six months post intervention. Post interventional assessment was done by pain physician who were kept blind to the grouping process. Results: Neck disability index (1ry outcome), Nocturnal pain VAS, and severity of headache showed significant differences during the whole post-interventional study period. The patients in RF group demonstrated significant improvement of pain in comparison to baseline value over the whole six months with p-value Conclusion: Radiofrequency of 3rd Occipital Nerve is effective in treatment of refractory cervicogenic headache in RA. Disclosure of Interests: : None declared