Atlantoaxial arthrography. A postmortem study

Mellström, A.; Grepe, Arne; Levander, Bo

doi:10.1007/bf00341778

Cited by 8 publications

(4 citation statements)

References 11 publications

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“…The lateral atlantoaxial joints are laterally very narrow and a true lateral approach is not feasible. However, when the needle is introduced percutaneously just posterior and caudal to the mandibular angle, and directed slightly cranially and posteriorly, it can easily be advanced into the wider anterior portion of the lateral joint 13 . Such an anterolateral approach is believed to reduce the incidence of C2 nerve root injury, dura cuff puncture, epidural injection, and vertebral artery puncture.…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Pain Relief in Patients with Cervicogenic Headaches after Pulsed Radiofrequency Application into the Lateral Atlantoaxial (C1‐2) Joint Using an Anterolateral Approach

2010

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The lateral atlantoaxial joint has long been reported as a source of cervicogenic headache. We present a retrospective study, including 86 patients who had undergone lateral C1-2 joint pulsed radiofrequency application, for cervicogenic headache in a single pain center from March 2007 to December 2008. The percentage of patients who had >or=50% pain relief at 2 months, 6 months, and 1 year were 50% (43/86), 50% (43/86), and 44.2% (38/86), respectively. Long-term pain relief at 6 months and 1 year were predicted reliably by >or=50% pain relief at 2 months (P < 0.001). Apart from 1 patient that complained of increased severity of occipital headache lasting several hours, we had no other reported complications.

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Section: Discussionmentioning

confidence: 99%

Long‐Term Pain Relief in Patients with Cervicogenic Headaches after Pulsed Radiofrequency Application into the Lateral Atlantoaxial (C1‐2) Joint Using an Anterolateral Approach

2010

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“…Although a posterior approach is most commonly used to access the AA joint ( table 12 ), posterior oblique (also known as posterolateral) 160 and lateral approaches 50 51 have also been described. In light of the potential for vascular injury (internal jugular vein/vertebral artery) and vagal nerve injury, 160 along with access to a larger joint space posteriorly, 161 the posterior oblique and lateral approaches have for the most part been abandoned in clinical practice. 156 157 In one study evaluating 500 CT-angiograms performed for cerebrovascular accident or trauma, a loop of the vertebral artery was found on the lateral quarter of the dorsal aspect of the AA joint in 1% of individuals (0.6% on the left, 0.4% on the right).…”

Section: Question 6: What Is the Optimal Technique For Injection Into The Aa And Ao Joints? Should Steroids Be Used And If So What Type Omentioning

confidence: 99%

Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

Hurley

Adams

Barad

et al. 2021

Reg Anesth Pain Med

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BackgroundThe past two decades have witnessed a surge in the use of cervical spine joint procedures including joint injections, nerve blocks and radiofrequency ablation to treat chronic neck pain, yet many aspects of the procedures remain controversial.MethodsIn August 2020, the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine approved and charged the Cervical Joint Working Group to develop neck pain guidelines. Eighteen stakeholder societies were identified, and formal request-for-participation and member nomination letters were sent to those organizations. Participating entities selected panel members and an ad hoc steering committee selected preliminary questions, which were then revised by the full committee. Each question was assigned to a module composed of 4–5 members, who worked with the Subcommittee Lead and the Committee Chairs on preliminary versions, which were sent to the full committee after revisions. We used a modified Delphi method whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chairs, who incorporated the comments and sent out revised versions until consensus was reached. Before commencing, it was agreed that a recommendation would be noted with >50% agreement among committee members, but a consensus recommendation would require ≥75% agreement.ResultsTwenty questions were selected, with 100% consensus achieved in committee on 17 topics. Among participating organizations, 14 of 15 that voted approved or supported the guidelines en bloc, with 14 questions being approved with no dissensions or abstentions. Specific questions addressed included the value of clinical presentation and imaging in selecting patients for procedures, whether conservative treatment should be used before injections, whether imaging is necessary for blocks, diagnostic and prognostic value of medial branch blocks and intra-articular joint injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for designating a block as positive, how many blocks should be performed before radiofrequency ablation, the orientation of electrodes, whether larger lesions translate into higher success rates, whether stimulation should be used before radiofrequency ablation, how best to mitigate complication risks, if different standards should be applied to clinical practice and trials, and the indications for repeating radiofrequency ablation.ConclusionsCervical medial branch radiofrequency ablation may provide benefit to well-selected individuals, with medial branch blocks being more predictive than intra-articular injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of false-negatives (ie, lower overall success rate). Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice.

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“…Although a posterior approach is most commonly used to access the AA joint ( table 12 ), posterior oblique (also known as posterolateral) [ 160 ] and lateral approaches [ 50 51 ] have also been described. In light of the potential for vascular injury (internal jugular vein/vertebral artery) and vagal nerve injury, [ 160 ] along with access to a larger joint space posteriorly, [ 161 ] the posterior oblique and lateral approaches have for the most part been abandoned in clinical practice [ 156, 157 ] In one study evaluating 500 CT-angiograms performed for cerebrovascular accident or trauma, a loop of the vertebral artery was found on the lateral quarter of the dorsal aspect of the AA joint in 1% of individuals (0.6% on the left, 0.4% on the right) [ 162 ] In the anteroposterior view, AA joint visualization is optimized with cephalocaudal tilt. The optimal target point is the junction of the lateral one-third and medial two-thirds of the AA joint to minimize the risk of vertebral artery injury (which is generally lateral to the joint line), contacting the C2 nerve root, or dural puncture with intrathecal spread of injectate [ 156, 157, 163 ] The joint may be accessed either via a straight coaxial trajectory or after first making contact with the periosteum along the joint margin to establish depth [ 157 ] After confirmation of IA needle placement in posteroanterior and lateral views, and with a very small volume of contrast injected under DSA or real-time fluoroscopy, ≤0.5 mL of injectate is typically used, as is illustrated in all but one of the clinical studies where the volume of injectate was described ( table 12 ).…”

Section: Question 6: What Is the Optimal Technique For Injection Into The Aa And Ao Joints? Should Steroids Be Used And If So What Type Omentioning

confidence: 99%

Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

et al. 2021

View full text Add to dashboard Cite

Background The past two decades have witnessed a surge in the use of cervical spine joint procedures including joint injections, nerve blocks and radiofrequency ablation to treat chronic neck pain, yet many aspects of the procedures remain controversial. Methods In August 2020, the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine approved and charged the Cervical Joint Working Group to develop neck pain guidelines. Eighteen stakeholder societies were identified, and formal request-for-participation and member nomination letters were sent to those organizations. Participating entities selected panel members and an ad hoc steering committee selected preliminary questions, which were then revised by the full committee. Each question was assigned to a module composed of 4–5 members, who worked with the Subcommittee Lead and the Committee Chairs on preliminary versions, which were sent to the full committee after revisions. We used a modified Delphi method whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chairs, who incorporated the comments and sent out revised versions until consensus was reached. Before commencing, it was agreed that a recommendation would be noted with >50% agreement among committee members, but a consensus recommendation would require ≥75% agreement. Results Twenty questions were selected, with 100% consensus achieved in committee on 17 topics. Among participating organizations, 14 of 15 that voted approved or supported the guidelines en bloc, with 14 questions being approved with no dissensions or abstentions. Specific questions addressed included the value of clinical presentation and imaging in selecting patients for procedures, whether conservative treatment should be used before injections, whether imaging is necessary for blocks, diagnostic and prognostic value of medial branch blocks and intra-articular joint injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for designating a block as positive, how many blocks should be performed before radiofrequency ablation, the orientation of electrodes, whether larger lesions translate into higher success rates, whether stimulation should be used before radiofrequency ablation, how best to mitigate complication risks, if different standards should be applied to clinical practice and trials, and the indications for repeating radiofrequency ablation. Conclusions Cervical medial branch radiofrequency ablation may provide benefit to well-selected individuals, with medial branch blocks being more predictive than intra-articular injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of false-negatives (ie, lower overall success rate). Clinical trials should be tailored b...

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Atlantoaxial arthrography. A postmortem study

Abstract: The atlantoaxial joints of nine cadavers were examined with Amipaque. A lateral percutaneous approach was elaborated. Interarticular communications and pertinent anatomical features were analyzed.

Cited by 8 publications

References 11 publications

Long‐Term Pain Relief in Patients with Cervicogenic Headaches after Pulsed Radiofrequency Application into the Lateral Atlantoaxial (C1‐2) Joint Using an Anterolateral Approach

Long‐Term Pain Relief in Patients with Cervicogenic Headaches after Pulsed Radiofrequency Application into the Lateral Atlantoaxial (C1‐2) Joint Using an Anterolateral Approach

Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

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