Disclosures: Jonathan Ramin, DO: Nothing to disclose

Case Description: After failed conservative management, a patient with primarily C1-C2 facet-mediated pain was successfully treated with PRP to the C1-C2 facet joint.

Setting: Outpatient Spine Center

Patient: 69-year-old female presented with progressively worsening neck pain that radiated to the right posterior auricular area for the last 9 months. The pain was rated 10/10, aggravated by extension of her neck and associated with headaches. Physical exam was significant for pain with cervical extension. Right-sided facet loading reproduced her symptoms and imaging revealed significant C1-C2 arthropathy.

Assessment/Results: Conservative management was unsuccessful. We trialed corticosteroid injections to the right C1-C2, C2-C3 intraarticular facets, providing only short-term relief. Symptoms recurred, hence we decided to trial a series of fluoroscopy guided PRP injections to the right C1-2 facet joint. The initial PRP injection provided mild relief of symptoms and was repeated 3 months later. Four weeks following the second injection, the patient experienced 90% relief that has sustained for 4 months and counting.

Discussion: Cervical facet arthropathy affects the function of the zygapophysial joints in the cervical region. When conservative treatment fails, interventional procedures are considered, specifically intra-articular corticosteroid injections and radiofrequency ablation (RFA). While techniques for C1-C2 facet injections are well described, it is difficult to perform and not often attempted. Additionally, RFA cannot be performed at the C1-C2 level. Recent evidence suggesting effectiveness of PRP when used in the sacroiliac joint and lumbar spine prompted our trial of PRP to the cervical spine. After only short-term success with corticosteroids, our case demonstrated 90% resolution of symptoms related to facet arthropathy just 4 weeks after fluoroscopy guided intra-articular C1-C2 PRP injection.

Conclusion: Although C1-C2 facet injections are uncommonly performed, and literature regarding the application of PRP is scarce, our case provides clinical support for a potentially effective and novel treatment utilizing PRP to treat upper cervical facet arthropathy.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/treating-c1-c2-facet-arthropathy-with-platelet-rich-plasma-prp-a-case-report/