Cervicogenic headache. Smith/Robinson approach in bilateral cases.

The aim was to follow the postoperative fate of cervicogenic headache (CEH) patients with a hard-to-treat, bilateral headache, operated upon by the Smith/Robinson procedure, a stabilization and decompression operation in the cervical spine. CEH is a typically unilateral headache, but in this study, bilateral cases were deliberately selected (n=28). The patients were, otherwise, diagnosed according to the Cervicogenic Headache International Study Group (CHISG) CEH criteria. In most cases, the discs C 4-5 , C 5-6 and C 6-7 were affected, and one or two discs were removed by anterior approach; an interbody fusion was carried out. Immediately postoperatively - up to 2-3 months - there was pain freedom. Secondary deterioration was reported to us in 10 patients, in nine of whom it occurred within three years. The remaining 18 patients were followed up for 2-100 months; the mean duration of improvement was 22.7 months. Bilateral, Smith/Robinson operated CEH patients seemed to fare as well as unilateral ones.