Performance of the CT-Guided C1–C2 Facet (Lateral Atlantoaxial Joint) Injection

ABSTRACT

CT-guided C1–C2 facet joint injections are a valuable tool for managing cervicogenic headaches caused by degenerative and inflammatory conditions of the atlantoaxial joint. This video article presents the procedural technique for a CT-guided C1–C2 facet joint injection in a patient with left-sided cervicogenic headache. Despite concerns regarding potential complications such as vascular injury to the vertebral artery and nerve injury to the C2 dorsal root ganglion, careful anatomic planning and imaging guidance allows safe and effective treatment. The injection involves precise needle placement between the vertebral artery and the C2 dorsal root ganglion, followed by contrast injection to confirm positioning and administration of a steroid-anesthetic mixture. Preprocedural imaging and safety precautions such as reviewing the international normalized ratio and platelet levels are essential. While rare adverse events have been reported, this technique remains a valuable option for pain relief in patients unresponsive to conservative therapies.