Lateral atlanto-axial joint access using the C2 pedicle.

Area of Science:

• Pain Management
• Interventional Radiology
• Anatomy

Background:

• Neck pain and headaches can originate from the lateral atlanto-axial (LAA) joint.
• Diagnosis often involves intra-articular injections, but traditional posterior approaches pose risks due to nearby vital structures.
• These risks include proximity to the vertebral artery, dural sac, and C2 spinal nerve.

Purpose of the Study:

• To describe and evaluate a novel technique for accessing the LAA joint.
• The new approach aims to circumvent the hazardous posterior structures.
• This technique seeks to improve safety in diagnosing LAA joint-related pain.

Main Methods:

• A new needle insertion technique was developed, targeting the LAA joint.
• The trajectory is tangential to the dorsal surface of the C2 lamina.
• A declined C2 lamina and C2 pedicle view was utilized in 10 patients with unilateral suboccipital pain and LAA joint arthropathy.

Main Results:

• The C2 pedicle was consistently and easily identified in all patients.
• The needle successfully passed beneath the posterior neurovascular structures without complication.
• Tactile feedback from the C2 lamina guided accurate needle depth caudal to the LAA joint.

Conclusions:

• The described technique provides safe and effective access to the lateral atlanto-axial joint.
• It successfully avoids critical neurovascular structures posterior to the joint.
• This method offers a valuable alternative for LAA joint interventions and diagnosis.