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Atlanto-Axial Joint Injection: Computed Tomography and Fluoroscopy 

Atlanto-Axial Joint Injection: Computed Tomography and Fluoroscopy
Atlanto-Axial Joint Injection: Computed Tomography and Fluoroscopy
Multimodality Imaging Guidance in Interventional Pain Management

Lesley Lirette

and Marc A. Huntoon


Atlanto-axial (AA) joint injections can be helpful in the diagnosis and management of occipital headaches stemming from the AA joint. Because of the complicated anatomic landscape, imaging guidance is vital in addition to a sound understanding of the anatomy. Several different image modalities are available for use in AA joint blocks. Fluoroscopy is the most widely used for its familiarity, relative low cost, and wide availability. The addition of digital subtraction angiography to the conventional fluoroscope offers an additional safety benefit when performing injections near critical blood vessels. Computed tomography guidance offers a better view that allows for visualization of the soft-tissue structures; however, its risk/benefit ratio limits its use in the everyday pain practice. Flat detector CT may offer a promising compromise, incorporating delayed CT images into the conventional fluoroscopy procedure. Safety is the highest priority when performing AA joint blocks to prevent potentially devastating outcomes.

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