C0-C1 joint injection: Anatomical, clinical and technical review.

BACKGROUND

Cervicogenic headaches (CGH) are proven clinical entities. The prevalence of CGH arising from the atlanto-occipital (AO) joint is unknown. The best evidence for treatment of CGH is for third occipital nerve radiofrequency neurotomy. Treatment of CGH includes intra-articular injections into upper cervical spine joints.

OBJECTIVE

To perform a review of the anatomy and clinical presentation of AO joint (AOJ) pain referral as well as a technical description to safely access the AOJ.

METHODS

A literature review was performed to explore the intricacies of the cranio-cervical junction (CCJ) with a focus on the relation between the AOJ and vascular anatomy. Our technical approach is described with complementary images.

RESULTS

The AOJ lies anterior to a venous sinus and slightly superior to the horizontally oriented vertebral artery crossing the joint line.

CONCLUSION

The authors propose a modified superior needle trajectory that seeks to avoid these vascular structures and to access the AOJ safely.