Infiltration of the Craniovertebral Region

Abstract

The objective of this article is to explain the technique of C1-C2 arthrography as a suitable treatment for pain due to C1-C2 abnormalities. The technique is consistent with the puncture of the posterior aspect of the C1-C2 joint under fluoroscopic control. Arthrography is performed with 1 mL of contrast media. After that, 1 mL of long-acting steroid is injected. The articular cavity has an anterior recess and a posterior recess. The posterior recess is large and easily punctured. In 5% of cases, the ipsilateral joint is also opacified. This injection is indicated in cases of upper cervical pain because of C1-C2 osteoarthritis, inflammatory arthritis of the upper spine (rheumatoid disease, spondylarthritis), and cervico-occipital neuralgia (Arnold's neuralgia) of the same causes or of unknown local origin. C1-C2 arthrography appears to be an efficient and safe technique for the treatment of upper cervical pain due to C1-C2 abnormalities.Objectives: On completion of this article, the reader will understand the techniques and indications for treatment of pain due to C1-C2 abnormalities. Accreditation: Tufts University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. TUSM takes full responsibility for the content, quality, and scientific integrity of this continuing education activity. Credit: Tufts University School of Medicine designates this education activity for a maximum of 1.0 hour credit toward the AMA Physicians Recognition Award in category one. Each physician should claim only those hours that he/she actually spent in the educational activity.