The Q2 approach for percutaneous peripheral neuromodulation stimulator implantation targeting the C2 dorsal root ganglion at the C2 lamina for treatment of intractable headache: a technical note.

Objectives: Despite significant medical treatment advancements, interventional treatments for intractable headache disorders are limited. This study's objective is to detail a novel percutaneous approach (the "Q2 approach") and its technical considerations for implanting peripheral neuromodulation stimulators (PNS) to the C2 dorsal root ganglion (C2-DRG) at the C2 lamina, a previously unattempted target, as a treatment for intractable headache.

Methods: In an outpatient setting, under combined ultrasound and fluoroscopic guidance, PNS electrodes were percutaneously implanted at the C2-DRG in patients under moderate sedation. The final electrode position was determined by intraoperative patient feedback to ensure optimal stimulation. Four patients were included to demonstrate technical parameters and feasibility. Follow-ups were conducted on postoperative days 10, 30, 60, and 100-120.

Results: The Q2 approach allows safe C2-DRG PNS implantations in an outpatient setting. Average operative duration was <60 minutes. All 4 patients achieved >50% pain relief during the 60-day implant period, and 3 of 4 demonstrated sustained benefit beyond the implant period. No complications (eg, lead migration, infection) were observed.

Conclusions: The present technical note demonstrates the feasibility of a novel, safe, minimally invasive approach to access the C2-DRG at the C2 lamina for the treatment of intractable headaches. The use of PNS on the C2-DRG fills an important gap in headache management, as it provides an alternative neuromodulation treatment modality to the existing destruction/denervation-based techniques.