Paluzzi A, Belli A, Lafuente J, Wasserberg J
Department of Anatomy, Leicester & Warwick University Medical School, Leicester, UK.
Clin Anat. 2006 Sep;19(6):497-502. doi: 10.1002/ca.20206.
One of the most important structures involved in the pathogenesis of occipital headache is the lateral atlanto-axial joint. Previous studies demonstrated that injection of this joint with local anesthetic can alleviate occipital headache, while injection of contrast medium exacerbates it. The aim of our study is to improve the understanding of the nerve supply to the lateral atlanto-axial joint by the C2 nerve elements, in order to determine the optimal target for an anesthetic block of this area. Ten C2 spinal nerves and roots were dissected in five embalmed cadavers with the aid of a 40X microscope and the lateral atlanto-axial joint was shown to be extensively supplied by articular branches of C2 nerve elements (dorsal ganglion, spinal nerve, and ventral ramus). Following our observations on their distribution, we propose a target for local anesthetic injection of the C2 articular branches that is based on reliable landmarks and is easily identifiable at fluoroscopy. We suggest that local anesthetic injection at this target point could be of benefit in the relief of occipital pain due to cervical trauma or degenerative disease involving the lateral atlanto-axial joint.
枕部头痛发病机制中最重要的结构之一是寰枢外侧关节。先前的研究表明，向该关节注射局部麻醉剂可缓解枕部头痛，而注射造影剂则会加重头痛。我们研究的目的是增进对C2神经成分向寰枢外侧关节神经支配的理解，以便确定该区域麻醉阻滞的最佳靶点。在5具防腐尸体上借助40倍显微镜解剖了10条C2脊神经和神经根，结果显示寰枢外侧关节由C2神经成分（背根神经节、脊神经和腹支）的关节支广泛支配。根据我们对其分布的观察，我们提出了一个基于可靠标志且在荧光镜下易于识别的C2关节支局部麻醉注射靶点。我们认为，在此靶点注射局部麻醉剂可能有助于缓解因颈椎创伤或累及寰枢外侧关节的退行性疾病引起的枕部疼痛。
