OUTCOME OF SURGICAL DECOMPRESSION OF THE 2ND CERVICAL ROOT FOR CERVICOGENIC HEADACHE

OBJECTIVE: There is limited information on the surgical treatment of c ervicogenic headache (CH). The objective of this study is to analyze t he utility of microsurgical decompression of the second cervical (C2) root and ganglion as a treatment for CH. METHODS: Thirty-nine sequenti al C2 root and ganglion decompressions, performed for the treatment of CH on 35 patients at the Dartmouth-Hitchcock Medical Center during a 70-month period, were analyzed retrospectively. Preoperative factors a nd intraoperative findings were evaluated with respect to outcome. RES ULTS: At a mean follow-up of 21 months, 12 patients (13 sides) were pa in free, and 15 were adequately improved (18 sides). Treatment eventua lly failed in eight patients. No patient, however, was worse after sur gical intervention. There was no major morbidity or mortality associat ed with the operation. The eight patients with unsatisfactory outcome were evaluated for a possible second operation, and four underwent it. One patient of the four is pain free after 28 months, and two gained adequate improvement at 3 and 12 months. The fourth patient required a third operation but has achieved adequate relief-at 6 months. Thus, t he overall success rate (either pain free or with adequate improvement ) was 90%. No specific prognostic factors could be established, other than the accepted diagnostic criteria and successful anesthetic blocka de of the C2 root and ganglion. CONCLUSION: The results suggest that m icrosurgical decompression of the C2 root and ganglion has some utilit y in treating CH. The accepted diagnostic criteria and success of anes thetic blockade of C2 should identify the subset of patients with CH p redominantly caused by C2 root or ganglion effect at this level, which may favor surgical treatment.