Chronic pain originating from the lateral atlantoaxial (C1-C2) joint is a challenging condition with limited long-term treatment options. Conventional radiofrequency ablation (RFA) techniques rely on indirect guidance, which can lead to incomplete nerve denervation and variable outcomes. This report introduces awake endoscopic radiofrequency ablation (ERFA) as a novel, minimally invasive treatment, complemented by advanced diagnostic imaging. We present the case of a 67-year-old male with intractable occipital and posterior neck pain refractory to previous surgeries. Single-photon emission computed tomography (SPECT/CT) was crucial in identifying active inflammation localized to the left C1-C2 facet joint as the primary pain generator. The patient then underwent an awake ERFA procedure targeting the C1-C2 and C2-C3 facet joints. The endoscopic approach provided direct visualization of the target areas, allowing for precise and thorough ablation. The awake setting enabled real-time patient feedback, confirming immediate symptom relief of 80% upon completion. This case highlights that the combination of SPECT/CT for accurate diagnosis and awake ERFA for precise, visually-confirmed denervation presents a promising and effective modality for managing this condition, potentially offering more durable relief than conventional techniques.
Santipas et al. (2026) studied this question.