• Christopher Zarembinski and Robert Wright.
• Department of Anesthesiology, The Pain Center, Cedars Sinai Medical Center, Los Angeles, United States.
• Pain Med. 2024 Nov 1; 25 (11): 675678675-678.

BackgroundNeck pain and headaches can arise from the lateral atlanto-axial (LAA) joint. This pain can be diagnosed with intra-articular injections of local anesthetic. A widely used technique for access to the lateral atlanto-axial joint uses a posterior approach, but this approach can be hazardous because of the proximity of the vertebral artery, the dural sac, and the C2 spinal nerve and dorsal root ganglion.ObjectiveThe objective was to describe and test a new technique for accessing the LAA joint that avoids structures that lie behind the joint.InterventionsThe new technique was described and tested for tolerance in 10 patients with unilateral suboccipital pain and tenderness over the LAA joint, along with evidence of LAA joint arthropathy on SPECT CT. The technique requires inserting a needle along a trajectory tangential to the dorsal surface of the C2 lamina. It involves obtaining a declined view of the C2 lamina and C2 pedicle.ConclusionsIn all cases, the C2 pedicle was easily identified and allowed the needle to pass asymptomatically underneath the neurovascular structures behind the joint. The tactile response of the lamina of C2 provided important feedback regarding needle depth caudal to the LAA joint.© The Author(s) 2024. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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