J Korean Med Sci 2007; 22: 326-9 ISSN 1011-8934 Copyright The Korean Academy of Medical Sciences Clinical Efficacy of Radiofrequency Cervical Zygapophyseal Neurotomy in Patients with Chronic Cervicogenic Headache The purpose of the present study was to assess the clinical efficacy of radiofrequency (RF) cervical zygapophyseal joint neurotomy in patients with cervicogenic headache. A total of thirty consecutive patients suffering from chronic cervicogenic headaches for longer than 6 months and showing a pain relief by greater than 50% from diag- nostic/prognostic blocks were included in the study. These patients were treated with RF neurotomy of the cervical zygapophyseal joints and were subsequently assessed at 1 week, 1 month, 6 months, and at 12 months following the treatment. The results of this study showed that RF neurotomy of the cervical zygapophyseal joints significantly reduced the headache severity in 22 patients (73.3%) at 12 months after the treatment. In conclusion, RF cervical zygapophyseal joint neurotomy has shown to provide substantial pain relief in patients with chronic cervicogenic headache when carefully selected. Key Words : Cervicogenic Headache; Zygapophyseal Joint; Radiofrequency Neurotomy Jang Bo Lee, Jung Yul Park, Juno Park, Dong Jun Lim, Sang Dae Kim, Heung Seob Chung* Department of Neurosurgery, Korea University Ansan Hospital, Ansan; Korea University Guro Hospital*, Korea University School of Medicine, Seoul, Korea Received : 21 March 2006 Accepted : 24 July 2006 Address for correspondence Jung Yul Park, M.D. Department of Neurosurgery, Korea University Ansan Hospital, 516 Gojan-dong, Danwon-gu, Ansan 425-707, Korea Tel : +82.31-412-5053, Fax : +82.31-412-5054 E-mail : jypark@kumc.or.kr INTRODUCTION Cervicogenic headache, first described by Sjaastad (1), is characterized as unilateral fronto-temporal headache with clinical symptomatology similar to migraine (1, 2). Useful clinical diagnostic criteria were published in 1990 (3) and revised in 1998 (4). However, the concept of cervicogenic headache is not universally accepted, and the precise pathol- ogy in the neck that gives rise to the pain has not been com- pletely understood. Among the candidate structures are the upper cervical nerves (greater and lesser occipital nerves), nerve roots, cervical muscles, cervical discs and zygapophy- seal (facet) joints, and atlantoaxial and atlantooccipital joints. Cervicogenic headache may arise not only from the upper, but also from the middle and even from the lower cervical area (4). Various treatment modalities directed to these struc- tures have been attempted. Among the published approach- es, radiofrequency (RF) neurotomy of the cervical facet joints (5, 6) seems promising. The purpose of the study was to assess the clinical efficacy of RF cervical zygapophyseal joint neurotomy in patients with chronic cervicogenic headache to determine whether there was sufficient merit or usefulness in the procedure to justify its use in these patients. MATERIALS AND METHODS Patients were selected from the out patient clinic at our 326 institution during the March 2001-February 2003 period. Major criteria for the diagnosis of cervicogenic headache are (modified criteria from 1990 [3]) listed in Table 1. There were 46 with chronic (>6 months of duration) cer- vicogenic headache who met the above criteria. Among them, a total of thirty patients showed greater than 50% of pain relief from two diagnostic/prognostic C3-C4 cervical medial branch blocks and were followed up for more than 12 months. Those patients who needed multi-level cervical blocks and those who were involved in litigation or compensational pro- grams were excluded. Selected patients had relatively severe complaints inhibiting activity of daily living, participation in work or social life, and inadequate effect of appropriate prophylactic and/or therapeutic headache medication. There were 16 men and 14 women ranging in age from 35 to 67 yr with a mean age of 54 yr. Radiographic examinations of the cervical spine were carried out in order to evaluate an abnor- mal posture or flexion-extension impairment. There were no definitive structural abnormalities that could cause neurologic deficits on computed tomogram or magnetic resonance imag- ing study of brain or cervical spine. These patients were treat- ed with RF neurotomy on medial branch of posterior primary ramus and then were assessed at 1 week, 1 month, 6 months, and at 12 months following the treatment. All procedures were performed by a single neurosurgeon. A RF generator (RFG-3C Graphic, Radionics Inc., Burling- ton, MA, U.S.A.) with the SMK-C10 cannula (22 gauge; length, 10 cm; exposed tip, 5 mm) was used with appropri- ate connections and a wide diathermy ground plate. All pro-