Fluoroscopy- and Ultrasound-Guided Intra-Articular Pulsed Radiofrequency of the Atlanto-Occipital Joint for Chronic Post-Traumatic Neck Pain: A Retrospective Preliminary Case Series

Background/Objectives: To evaluate preliminary clinical outcomes, functional changes, and procedural safety associated with fluoroscopy- and ultrasound-guided intra-articular pulsed radiofrequency (PRF) of the atlanto-occipital joint in patients with chronic post-traumatic cervical pain. Methods: This retrospective preliminary case series included eight patients with chronic neck and/or head pain persisting for at least 6 months following whiplash injury or cervical hyperextension trauma. All patients underwent dual-guided intra-articular PRF of the atlanto-occipital joint. Pain intensity (Numeric Rating Scale, NRS), functional outcomes (Neck Disability Index, NDI; Patient-Specific Functional Scale, PSFS), and medication use were assessed at baseline and at 2, 3, and 6 months following the procedure. Results: Mean baseline NRS was 8.0 ± 0.76 and decreased to 2.38 ± 1.06 at 2 months, 3.38 ± 0.74 at 3 months, and 3.75 ± 1.16 at 6 months. A ≥ 50% reduction in pain intensity was observed in 87.5% of patients at 2 and 3 months and in 75.0% at 6 months. Functional outcome measures also showed improvement, with mean NDI scores decreasing from 60% at baseline to 25% at 2 months, with partial maintenance of improvement during follow-up. Mean PSFS scores increased from 3 at baseline to 7 at 2 months. Reduced use of analgesic and adjuvant medications was observed during follow-up. No serious procedure-related complications were identified. Conclusions: In this small retrospective case series, intra-articular PRF of the atlanto-occipital joint was associated with reductions in pain intensity, improvement in patient-reported functional outcomes, and reduced medication use in patients with chronic post-traumatic cervical pain. The procedure appeared technically feasible and well-tolerated. However, given the limited sample size and uncontrolled retrospective design, these findings should be interpreted cautiously and considered preliminary and hypothesis-generating rather than confirmatory. Prospective controlled studies are required to further evaluate potential efficacy, safety, and long-term outcomes.