Outcomes of C1–2 joint injections

Abstract

ObjectiveIntra-articular injections of the C1–2 joint are an effective therapeutic option for pain generated from degenerative and inflammatory conditions affecting the joint. Limited information exists about the adverse events (AEs) associated with these injections. The primary aim of this study is to describe the frequency and type of AEs associated with C1–2 joint injections. The secondary aim is to identify clinical factors associated with the occurrence of AEs of C1–2 joint injections.Design/methodsA retrospective chart review was conducted on all C1–2 joint injections performed at the Mayo Pain Medicine Clinic in Rochester, MN, from January 1, 2005 through July 31, 2015. AE data were extracted from procedural and post-procedural clinical notes. Analysis was conducted to determine correlations between any AE and demographic and clinical characteristics. Using univariate and multivariate logistic regression analyses, associations were determined.ResultsFrom January 1, 2005 to July 31, 2015, 135 C1–2 injections were performed on 72 patients. Overall, at least 1 AE was reported in 18.5% of the injections. The most common AEs were post-procedural increase in pain and procedural vascular contrast uptake. There was a significant association between AE occurrence and greater pre-procedural maximum pain score.ConclusionsAEs from C1–2 joint injections occurred commonly, but there were no persistent or serious AEs associated with these injections. The data also demonstrate that patients with higher pre-procedural maximum pain scores are more likely to experience an AE.

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

“…The risk of adverse events associated with AA joint injections was found to be 18.5% (25 of 72 patients) in a retrospective observational study. 163 In this cohort, no serious adverse events were reported and the most common side effects were dizziness, paresthesia, and/or increased pain. Vascular uptake on contrast injection (not differentiated between arterial or venous) was noted on real-time imaging or DSA during five of the injections that either resolved with needle repositioning or resulted in aborting the procedure due to safety concerns.…”

“…5 of 32 (16%) pts stopped opioid use and 3 of 32 (9%) pts had complete pain relief sustained at 9 months Zhou et al 2010167 31 pts with suspected cervicogenic headache who received AA joint, C2 and C3 dorsal rami, and C2-3 facet joint injection with LA and steroid Retrospective study 28 of 31 (90%) pts had >50% pain relief with an average duration of 21.7 days Used fluoroscopically-guided posterior approach. Pts also experienced decreased headache frequency and duration.3 non-responders diagnosed with temporomandibular disorder (n=2) and migraine (n=1).Aiudi et al 2017163 72 pts who received AA joint injections with LA and steroidRetrospective studyAdverse event rate was 25 of 135 (18.5%) injections with 13 procedural events (vascular uptake/paresthesia) and 12 post-procedural events (increased pain/neurologic symptoms) Used a fluoroscopically-guided posterior approach. No serious adverse events noted and all postprocedural adverse events resolved within 3 months.…”