Atlanto-Axial Joint Injection: Ultrasound

Abstract

The atlanto-axial joint accounts for up to 16% of patients with occipital headache. Distending the lateral atlanto-axial joint with contrast agent produces occipital pain, and injection of local anesthetic into the joint relieves the headache. The clinical presentation of atlanto-axial joint pain is not specific and therefore cannot be used alone to establish the diagnosis. The only means of establishing a definite diagnosis is a diagnostic block with intra-articular injection of local anesthetic. Intra-articular steroids are effective in short-term relief of pain originating from the lateral atlanto-axial joint. The major complication and limitation of the fluoroscopy-guided approach is the inability to identify and hence avoid vertebral artery injury. This chapter describes a new ultrasound-guided approach that will add more safety to the procedure.