Submitted by Rainier Guiang, M.D.

Atlanto-axial Joint Injection

Two needle technique: With patient in prone position with neck slightly flexed for comfort, take an AP picture and locate the dens. You may need cephalad tilt and the patient should be asked to open his/her mouth to faciliate the view. After sterile prep and drape, infiltrate the skin with local anesthetic. Infilitrate the underlying tissue using fluoroscopic guidance. Using an 18g angiocath as an introducer, guide your angiocath towards the direct center of the joint. The lateral border of the spinal cord may overlie the medial 1/4 of the joint and the vertebral artery may overlie the lateral 1/4 of the joint. Therefore you must be in the direct center to avoid these vital structures. Place a 25g spinal needle through your introducer and advance into the joint. Check your lateral view every once in a while to check depth. Once in the joint inject contrast dye to exclude intravascular injection. Inject local and steroid.

Below, see constrast dye just medial to the tip of the needle delineating the joint.

Below: lateral view showing the needle between C1 and C2 in the A-A joint.