Atlantooccipital Joint Intraarticular Injection

Chapter 36 Atlantooccipital Joint Intraarticular Injection



Tejas N. Parikh, Hwei (Willie) Lin, Michael B. Furman


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


The atlantooccipital (AO) joints uniquely connect the cervical spine (C1, the atlas) to the occiput base. The AO joints are condyloid joints. Unlike the lower cervical segments, the AO joints lack corresponding cervical discs and uncinate processes. In addition, the AO joints lie anterolateral to the spinal cord (rather than posterolateral), and they align with the uncinate processes of the lower cervical bodies. The AO joints are very mobile joints with primarily ligamentous stabilization, and they are considered to be synovial joints with capsules. The joints facilitate occipital flexion and extension on the atlas (C1).


Patients with AO joint pain often complain of unilateral suboccipital pain that can refer to the occipital and temporal regions but that does not include the vertex. This pain can occur after flexion and extension injuries.


Injection into the AO joint can be a challenging endeavor given the proximity of nearby vital neurovascular structures. Familiarity with the regional anatomy will minimize the adverse risks of potentially catastrophic consequences.


The ipsilateral oblique trajectory view and multiplanar imaging allow for safe needle placement into the AO joint avoiding the vital neurovascular structures. 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.



image Trajectory View (Figure 36–1)



image image image

Figure 36–1 A, Fluoroscopic image of a trajectory (i.e., ipsilateral oblique) view with the needle in position in the left atlantooccipital joint. B, Radiopaque structures, trajectory view. C, Radiolucent structures, trajectory view. Notice that the needle is placed in the lateral one-third of the AO joint.



image Notes on Positioning in the Trajectory View




image Clear the occipital brim.


image Line up and visualize the atlantooccipital joint as a sharp line.


image The anterior joint line is what is visualized; it is 1 to 2 mm inferior to the posterior portion.



image Trajectory View Safety Considerations




image Stay along the lateral third of the atlantooccipital joint superiorly. If the needle deviates, the only safe direction is superior.


image Avoid the spinal cord (SC), the dura, and the nerve roots (NR) by preventing the needle tip from straying too far medially.


image Avoid the vertebral artery by preventing the needle tip from straying too far medially, laterally, or inferiorly.


Place the patient in the prone position with the neck slightly flexed and the head supported.


Confirm the level (with the anteroposterior view).


Oblique the fluoroscope 25 to 30 degrees ipsilaterally (to the left, in this case).


Tilt the fluoroscope in a caudad direction to make a direct path to the AO joint (clearing the occipital brim) optimal and to visualize the AO joint as a sharp line so that it’s unobstructed by the occipital brim.


The target is the posterior aspect of the joint (because the patient is prone); however, the anterior joint line is what is visualized; it is 1 to 2 mm inferior to the posterior portion.

Related posts:

Atlantoaxial Joint Intraarticular Injection Lumbar Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy, Posterior Approach Thoracic Zygapophysial Joint Intraarticular Injection, Posterior Approach Thoracic Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy, Posterior Approach Lumbar Interlaminar Epidural Steroid Injection, Paramedian Approach Cervical Discography/Disc Access

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Dec 23, 2015 | Posted by in INTERVENTIONAL RADIOLOGY | Comments Off on Atlantooccipital Joint Intraarticular Injection

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