{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T05:05:39Z","timestamp":1780463139579,"version":"3.54.1"},"reference-count":30,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 \u00b1 0.76 and decreased to 2.38 \u00b1 1.06 at 2 months, 3.38 \u00b1 0.74 at 3 months, and 3.75 \u00b1 1.16 at 6 months. A \u2265 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.<\/jats:p>","DOI":"10.3390\/jcm15114081","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T14:10:22Z","timestamp":1779718222000},"page":"4081","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fluoroscopy- and Ultrasound-Guided Intra-Articular Pulsed Radiofrequency of the Atlanto-Occipital Joint for Chronic Post-Traumatic Neck Pain: A Retrospective Preliminary Case Series"],"prefix":"10.3390","volume":"15","author":[{"given":"Pawe\u0142","family":"Gogol","sequence":"first","affiliation":[{"name":"Neurolocus Pain Management Centre, 04-281 Warsaw, Poland"},{"name":"Pain Treatment Clinic, Our Lady of Perpetual Help Hospital in Wo\u0142omin, 05-200 Wo\u0142omin, Poland"},{"name":"Department of Neurosurgery, Faculty of Medicine, Academy of Silesia, 40-555 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7845-8187","authenticated-orcid":false,"given":"Ma\u0142gorzata","family":"Gierczak","sequence":"additional","affiliation":[{"name":"Individual Practice, Osteo Clinic, 02-401 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Szczepaniak","sequence":"additional","affiliation":[{"name":"Neurolocus Pain Management Centre, 04-281 Warsaw, Poland"},{"name":"Pain Treatment Clinic, Our Lady of Perpetual Help Hospital in Wo\u0142omin, 05-200 Wo\u0142omin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafa\u0142","family":"Pasztaleniec","sequence":"additional","affiliation":[{"name":"Pain Medicine Centre, 64-920 Pi\u0142a, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafa\u0142","family":"Wi\u015bniewski","sequence":"additional","affiliation":[{"name":"Neurolocus Pain Management Centre, 04-281 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ma\u0142gorzata","family":"Malec-Milewska","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0781-6534","authenticated-orcid":false,"given":"Rafa\u0142","family":"Staszkiewicz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Academy of Silesia, 40-555 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1633-7145","authenticated-orcid":false,"given":"Beniamin Oskar","family":"Grabarek","sequence":"additional","affiliation":[{"name":"Collegium Medicum, WSB University, 41-300 D\u0105browa G\u00f3rnicza, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2684-3757","authenticated-orcid":false,"given":"Micha\u0142","family":"Sobstyl","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Menchetti, P.P.M. (2022). Functional Anatomy and Biomechanics of the Cervical Spine. Cervical Spine: Minimally Invasive and Open Surgery, Springer International Publishing.","DOI":"10.1007\/978-3-030-94829-0"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Debnath, U.K. (2023). Biomechanics of Cervical Spine. Handbook of Orthopaedic Trauma Implantology, Springer.","DOI":"10.1007\/978-981-15-6278-5_113-2"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"37099","DOI":"10.52965\/001c.37099","article-title":"Pathoanatomy, biomechanics, and treatment of upper cervical ligamentous instability: A literature review","volume":"14","author":"Vij","year":"2022","journal-title":"Orthop. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.12786\/bn.2023.16.e15","article-title":"Post-Traumatic Craniocervical Disorders From a Postural Control Perspective: A Narrative Review","volume":"16","author":"Belhassen","year":"2023","journal-title":"Brain Neurorehabilit."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"415","DOI":"10.4103\/aam.aam_291_24","article-title":"Anatomical Study and Clinical Significance of Atlanto-occipital and Atlantoaxial Assimilation Anomaly in Asian Population","volume":"24","author":"Chakravarthi","year":"2025","journal-title":"Ann. Afr. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1007\/s11916-001-0029-7","article-title":"Cervicogenic headache: Anatomic basis and pathophysiologic mechanisms","volume":"5","author":"Bogduk","year":"2001","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"102804","DOI":"10.1016\/j.msksp.2023.102804","article-title":"Neck pain and headache: Pathophysiology, treatments and future directions","volume":"66","author":"Ashina","year":"2023","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"03331024231214731","DOI":"10.1177\/03331024231214731","article-title":"The International Classification of Headache Disorders: History and future perspectives","volume":"44","author":"Olesen","year":"2024","journal-title":"Cephalalgia"},{"key":"ref_9","first-page":"1","article-title":"Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition","volume":"38","author":"Arnold","year":"2018","journal-title":"Cephalalgia"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1097\/BRS.0b013e318053ec50","article-title":"Cervical Transforaminal Epidural Steroid Injections: More Dangerous Than We Think?","volume":"32","author":"Scanlon","year":"2007","journal-title":"Spine"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Singh, V., Falco, F.J.E., Kaye, A.D., Soin, A., and Hirsch, J.A. (2024). Atlanto-Occipital and Atlanto-Axial Interventions. Essentials of Interventional Techniques in Managing Chronic Pain, Springer International Publishing.","DOI":"10.1007\/978-3-031-46217-7"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"46","DOI":"10.25259\/SNI_1096_2024","article-title":"Advancements in occipitocervical fusion: Biomechanical insights, surgical techniques, and clinical outcomes","volume":"16","author":"Faraj","year":"2025","journal-title":"Surg. Neurol. Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e30525","DOI":"10.1016\/j.heliyon.2024.e30525","article-title":"Comparing the efficacy and safety of high-voltage and standard-voltage pulsed radiofrequency for the treatment of postherpetic neuralgia: A pooled analysis from randomized controlled trials","volume":"10","author":"Cai","year":"2024","journal-title":"Heliyon"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"111419","DOI":"10.1016\/j.intimp.2023.111419","article-title":"Pulsed radiofrequency on DRG inhibits hippocampal neuroinflammation by regulating spinal GRK2\/p38 expression and enhances spinal autophagy to reduce pain and depression in male rats with spared nerve injury","volume":"127","author":"Xu","year":"2024","journal-title":"Int. Immunopharmacol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1007\/s11845-023-03598-x","article-title":"A new neuromodulation method in chronic migraine; non-\u0131nvasive pulsed radiofrequency, a single-blinded, randomised, controlled trial","volume":"193","author":"Can","year":"2024","journal-title":"Ir. J. Med. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s41984-023-00189-x","article-title":"Interventional non-operative management of low back and neck pain","volume":"38","author":"Alkosha","year":"2023","journal-title":"Egypt. J. Neurosurg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1111\/ner.13105","article-title":"Pulsed Radiofrequency Neuromodulation Contributes to Activation of Platelet-Rich Plasma in In Vitro Conditions","volume":"24","author":"Michno","year":"2021","journal-title":"Neuromodulation Technol. Neural Interface"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"200","DOI":"10.12701\/jyms.2022.00101","article-title":"The mechanism of action of pulsed radiofrequency in reducing pain: A narrative review","volume":"39","author":"Park","year":"2022","journal-title":"J. Yeungnam Med. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1097\/BRS.0000000000002414","article-title":"Clinical Effectiveness of Intra-articular Pulsed Radiofrequency Compared to Intra-articular Corticosteroid Injection for Management of Atlanto-occipital Joint Pain: A Prospective Randomized Controlled Pilot Study","volume":"43","author":"Shin","year":"2018","journal-title":"Spine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e638","DOI":"10.1016\/j.wneu.2018.07.227","article-title":"Effect of Pulsed Radiofrequency Therapy on Chronic Refractory Atlanto-Occipital Joint Pain","volume":"119","author":"Tak","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.pain.2006.09.002","article-title":"Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: A double blind sham controlled randomized clinical trial","volume":"127","author":"Patijn","year":"2007","journal-title":"Pain"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e11761","DOI":"10.1097\/MD.0000000000011761","article-title":"Effectiveness of pulsed radiofrequency treatment on cervical radicular pain: A meta-analysis","volume":"97","author":"Kwak","year":"2018","journal-title":"Medicine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"03331024251322446","DOI":"10.1177\/03331024251322446","article-title":"Prevalence and relative frequency of cervicogenic headache in population- and clinic-based studies: A systematic review and meta-analysis","volume":"45","author":"Robinson","year":"2025","journal-title":"Cephalalgia"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/S1474-4422(09)70209-1","article-title":"Cervicogenic headache: An assessment of the evidence on clinical diagnosis, invasive tests, and treatment","volume":"8","author":"Bogduk","year":"2009","journal-title":"Lancet Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Seo, S.-S. (2021). Intra-articular Injection Therapy and Biologic Treatment. A Strategic Approach to Knee Arthritis Treatment: From Non-Pharmacologic Management to Surgery, Springer.","DOI":"10.1007\/978-981-16-4217-3"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1111\/j.1526-4637.2005.00076.x","article-title":"Electric and Thermal Field Effects in Tissue Around Radiofrequency Electrodes","volume":"6","author":"Cosman","year":"2005","journal-title":"Pain Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"492","DOI":"10.2519\/jospt.2017.7052","article-title":"Dizziness, U006Esteadiness, Visual Disturbances, and Sensorimotor Control in Traumatic Neck Pain","volume":"47","author":"Treleaven","year":"2017","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Li, Y., Yang, L., Dai, C., and Peng, B. (2022). Proprioceptive Cervicogenic Dizziness: A Narrative Review of Pathogenesis, Diagnosis, and Treatment. J. Clin. Med., 11.","DOI":"10.3390\/jcm11216293"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/s40122-020-00230-z","article-title":"Cervical Proprioception Impairment in Neck Pain-Pathophysiology, Clinical Evaluation, and Management: A Narrative Review","volume":"10","author":"Peng","year":"2021","journal-title":"Pain Ther."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2443","DOI":"10.1093\/pm\/pnab281","article-title":"Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group","volume":"22","author":"Hurley","year":"2021","journal-title":"Pain Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4081\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T04:23:59Z","timestamp":1780460639000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4081"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":30,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15114081"],"URL":"https:\/\/doi.org\/10.3390\/jcm15114081","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]}}}