Lateral atlantoaxial (C1-C2) joint steroid injections: a 22-year retrospective characterization of technique and clinical outcomes.

BACKGROUND AND PURPOSE: Intra-articular injection of the lateral atlantoaxial joint is used for occipital pain; however, limited literature exists on technique demonstration, adverse event reporting, and real-world clinical outcomes. This study was designed to characterize procedural technique, describe clinical outcomes, and report subsequent cervical fusion rates following lateral atlantoaxial joint injections.

MATERIALS AND

METHODS

A retrospective cohort analysis was conducted on all lateral atlantoaxial joint injections performed at our institution from January 1, 2002, through August 1, 2024. Descriptive statistics characterized the cohort, procedural features, pain score changes, and cervical fusion rates during follow-up.

RESULTS

140 lateral atlantoaxial joint injections were performed on 104 patients (mean age 72.6 ± 12.4 years, 68.3% female), primarily by fluoroscopy (77.1%). Mean pre-injection pain was 5.99 ± 1.96, with immediate post-injection pain at 1.84 ± 2.33 and 1-month clinic visit pain at 4.28 ± 2.68. Significant reductions in pain from pre-injection were observed immediately post-injection (P < .0001) and at 1 month (P < .0001). Most injections were successful on the first attempt (97.1%), with no serious adverse events identified throughout follow-up documentation. Overall, 26.9% of patients underwent cervical fusion involving the C1-C2 level during available follow-up.

CONCLUSION

This study comprises the largest cohort of patients with image-guided lateral atlantoaxial joint injections and provides descriptive data on technique, clinical outcomes, adverse events, and observed subsequent cervical fusion rates. Short-term reductions in pain were common 1 month from injections with no serious adverse events identified throughout follow-up and only one-quarter of patients undergoing eventual cervical fusion. This study adds valuable data to an uncommonly performed procedure.