Atlanto-Occipital and Atlanto-Axial Interventions

The atlanto-occipital (AO) and atlanto-axial (AA) joint pathology is a common source for neck pain and headache. The joints are susceptible to arthritis and can be injured during acceleration/deceleration (“whiplash”) injuries. Pain following such injuries is often initially wrongly attributed to soft-tissue injuries such as muscle strain. Injections in the AO or AA joints can be valuable both as diagnostic measures during the workup for headaches and being a viable therapeutic option once the diagnosis has been confirmed. Due to the invasive nature and risk for injury, the criteria for a positive response to anesthetic blockade are stringent: pain must be reduced by 80% or more, ideally with a dual block paradigm. Currently, there are limited studies indicating, in addition to intraarticular injections, pulsed radiofrequency treatment within the AO and AA joint can lead up to 6 months and 12 months of pain relief, respectively.