Literature Review: Management of Primary Atlantoaxial Osteoarthritis and Associated Occipital Neuralgia.

Primary atlantoaxial osteoarthritis, or C1-C2 (cervical 1-cervical 2) lateral mass arthritis, is an increasingly recognized but often underdiagnosed source of upper cervical and occipital pain, particularly in older adults. Unlike subaxial cervical spondylosis, which typically causes diffuse neck or upper back pain, this condition usually produces localized pain in the upper neck, occiput, or behind the ear, without frequent neurological symptoms. Clinical presentation is often unilateral, with pain exacerbated by lateral flexion and rotation, and diagnosis relies on radiographic and magnetic resonance imaging (MRI) findings showing joint space narrowing, sclerosis, osteophytes, and marrow edema. Conservative management, including nonsteroidal anti-inflammatory drugs (NSAIDs), soft collars, physiotherapy, and corticosteroid injections, is effective for many patients, but persistent, refractory pain may necessitate surgical intervention such as posterior C1-C2 fusion, which provides robust segmental stabilization and lasting relief. Emerging minimally invasive techniques, such as computed tomography (CT)-guided radiofrequency ablation of the C2 dorsal root ganglion, may offer an intermediate option for select patients. Most studies guiding management are retrospective, underscoring the need for prospective research to refine diagnostic and therapeutic approaches for this condition.