Pain-free survival after endoscopic neurotomy versus radiofrequency ablation of the C2 dorsal root ganglion for cervicogenic headache: a real-world comparison study.

BACKGROUND

Cervicogenic headache (CEH) is commonly treated with radiofrequency ablation (RFA) targeting the C2 dorsal root ganglion (DRG), yet the durability of analgesia is often limited. Endoscopic neurotomy (EN) enables direct visualization of the target neural structures and may provide more sustained pain relief; however, supporting evidence remains limited. We compared long-term outcomes of EN versus RFA targeting the C2 DRG in CEH.

METHODS

Patients with a positive diagnostic C2 DRG block were treated with EN or RFA. The Numerical Rating Scale (NRS), EuroQol 5-Dimension 5-Level (EQ-5D-5L), and Patient Global Impression of Change (PGIC) were obtained at baseline, and at 3 and 12 months postoperatively. The pain-free duration was recorded at every follow-up. The final follow-up was conducted in January 2026.

RESULTS

Of 76 included patients, 21 underwent EN and 55 underwent RFA. Both groups demonstrated significant reductions in NRS and improvements in EQ-5D-5L at 3 and 12 months postoperatively compared with baseline (P < 0.001). NRS and EQ-5D-5L outcomes were comparable between groups at 3 months (P > 0.05), whereas EN showed superior effectiveness at 12 months (P < 0.05). PGIC favored EN at both 3 and 12 months (P < 0.05). No serious adverse events were observed in either group, although occipital-distribution numbness occurred in 21/21 (100%) EN patients and 48/55 (87.3%) RFA patients. Median pain-free duration was 33 months in the EN group and 8 months in the RFA group (P < 0.05).

CONCLUSIONS

In this retrospective cohort, both EN and RFA improved pain and quality of life in clinically selected patients with CEH. EN was associated with longer pain-free duration; however, given its invasiveness and the diagnostic overlap between CEH and occipital neuralgia, EN should be considered cautiously as an escalation option in carefully evaluated patients.