1408 - Cryoneurolysis for Cervical Dystonia and Intractable Cervicalgia in a Nonagenarian: A Minimally Invasive Salvage Approach

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Co-Author(s)

MD

Mustafa R. Dodurgali, MD

Resident Physician
Yale School of Medicine
New Haven, Connecticut, United States

Presenting Author(s)

CB

Cole T. Bridges, DO

Resident Physician
Yale New Haven Health
New Haven, Connecticut, United States

Co-Author(s)

AP

Avish S. Persaud, MD

Resident doctor
Yale New Haven Health
Rochester Hills, Michigan, United States
CO

Charles A. Odonkor, MD, MA, FAAPMR

Assistant Professor of Orthopedics & Rehabilitation
Yale University School of Medicine
NEW HAVEN, Connecticut, United States

Submitter(s)

MD

Mustafa R. Dodurgali, MD

Yale School of Medicine
New Haven, Connecticut, United States

Case Diagnosis: Refractory cervical dystonia and chronic cervicalgia in a 92-year-old female, unresponsive to conservative and chemodenervation therapies, successfully treated with ultrasound-guided cryoneurolysis.

Case Description: A 92-year-old female with cervical spondylosis, dystonia, peripheral neuropathy, and a history of falls presented with chronic posterior cervical pain, dystonic posturing, and limited neck range of motion. Conservative management—including physical therapy, gabapentin, NSAIDs, occipital and facet nerve blocks, and massage—provided no durable relief. Multiple sessions of botulinum toxin injections (targeting trapezius, levator scapulae, scalene complex, and sternocleidomastoid muscles) were ineffective. Cervical MRI showed multilevel degenerative changes without myelopathy.
Given her advanced age, polypharmacy concerns, and limited response to prior interventions, a minimally invasive salvage strategy was pursued. She underwent ultrasound-guided cryoneurolysis of the right third occipital, greater and lesser occipital nerves, and cervical medial branches (C3–C5). The procedure was performed under local anesthesia and was well tolerated, resulting in immediate and sustained pain relief with improved active neck rotation and reduced postural dystonia.

Discussions: Refractory cervical dystonia and axial neck pain in elderly patients pose therapeutic challenges when conventional pharmacologic or interventional strategies fail. Cryoneurolysis, which induces reversible Wallerian degeneration via focused cold application, offers a non-opioid, outpatient alternative with temporary analgesia and preserved motor function. Advances in ultrasound technology have enhanced procedural precision and safety, making this modality increasingly viable for geriatric patients with complex spasticity or neuropathic pain syndromes. As such, cryoneurolysis represents an important and underutilized component of the physiatrist’s toolkit for managing complex pain and spasticity syndromes—particularly in geriatric populations with limited treatment options.

Conclusions: Ultrasound-guided cryoneurolysis may serve as a safe, effective, and opioid-sparing intervention for cervical dystonia and cervicalgia in older adults. This case illustrates its role as a minimally invasive salvage option in patients with contraindications to systemic therapies or failed prior interventions.