Chapter 35 Atlantoaxial Joint Intraarticular Injection

Note: Please see page ii for a list of anatomical terms/abbreviations used in this book.

The atlantoaxial joints are the paired articulations between the superior articulating processes of the axis and the inferior articulating processes of the atlas. These joints are primarily responsible for the 0 to 45 degrees of lateral rotation in each direction of the cervical spine.¹ These joints can become a source of axial cervical pain in the event of cervical trauma or as a result of degenerative joint disease. In the presence of atlantoaxial joint arthropathy, pain is usually exacerbated by cervical rotation. The distribution of axial cervical pain from atlantoaxial joint arthropathy usually involves the ipsilateral retromastoid, suboccipital, or posteroauricular region.^2–4

Atlantoaxial joint injections are indicated for the diagnosis and treatment of upper cervical and headache pain that emanates from the atlantoaxial joints of the cervical spine. For patients with predominately unilateral pain, the ipsilateral joint is injected. These joints can be injected with the use of either a lateral or posterior approach. The posterior approach is widely considered to be a safer technique, because fewer vital vascular and neural structures are encountered between the skin and joint line when using this trajectory.⁵

In this chapter, a posterior approach is described for the injection of the atlantoaxial joints. With this approach, the joint is accessed by using a trajectory view and advanced with the use of multiplanar imaging, with an emphasis on safety and using the lateral view to confirm depth. Because the lateral view is used to assess depth, one need not “step off” of the inferior or superior articulation of the joint before penetrating the joint capsule, as is often recommended. With this approach, the trajectory view is an anteroposterior view with a slight caudad tilt (i.e., a pillar view); this also serves as one of the multiplanar views.

It is crucial to target precisely the lateral one third of the AO joint because straying too far medially, laterally, or inferiorly can have devastating consequences.

Trajectory View (Figure 35–1)

Trajectory View Safety Considerations

Avoid penetrating the vertebral artery by not going beyond the lateral border of the joint space.

Avoid the C2 spinal nerve, the C2 dorsal root ganglion, and the spinal cord by staying medial to the junction of the lateral one third and the medial two thirds of the joint space.

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