Ann Rehabil Med.  2012 Oct;36(5):627-632.

Feasibility of Ultrasound Guided Atlanto-occipital Joint Injection

• Won SJ
• Lee UY
• Cho SU
• Rhee WI

Abstract

OBJECTIVE
To evaluate the feasibility of ultrasound guided atlanto-occipital joint injection. METHOD: Six atlanto-occipital joints of three cadavers were examined. Cadavers were placed in prone position with their head slightly rotated towards the contra-lateral side. The atlanto-occipital joint was initially identified with a longitudinal ultrasound scan at the midline between occipital protuberance and mastoid process. Contrast media 0.5cc was injected into the atlanto-occipital joint using an in-plane needle approach under ultrasound guide. The location of the needle tip and spreading pattern of the contrast was confirmed by fluoroscopic evaluation.
RESULTS
After ultrasound guided atlanto-occipital joint injection, spreading of the contrast media into the joint was seen in all the injected joints in the anterior-posterior fluoroscopic view.
CONCLUSION
The ultrasound guided atlanto-occipital injection is feasible. The ultrasound guided injection by Doppler examination can provide a safer approach to the atlanto-occipital joint.

Keyword

Atlanto-occipital joint; Cadaver study; Ultrasound guided injection

MeSH Terms

Atlanto-Occipital Joint
Cadaver
Contrast Media
Head
Joints
Mastoid
Needles
Prone Position
Contrast Media

Figure

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  Fig. 1 Ultrasound guided atlanto-occipital joint injection. (A) In ultrasound view of living body at the longitudinal scan below the mastoid process, C1 transverse process (arrow) and C2-3 facet joint (arrowhead) are shown. (B) Doppler examination in living body. Vertebral artery is visualized between C1 transverse process and occiput. (C) In ultrasound view of living body with a longitudinal scan at the mid-point between mastoid process and occipital protuberance, atlanto-occipital joint (asterix) is seen between C1 transverse process (arrow) and occiput (arrowhead). (D) In ultrasound view of cadaver, same as C, atlanto-occipital joint (asterix), C1 transverse process (arrow), and occiput (arrowhead) are shown. The atlanto-occipital joint is more clearly visualized than in living body. (E) In real time ultrasound guided injection, needle (arrowhead) is placed at the atlanto-occipital joint. (F) Needle insertion point is the mid-point between occipital protuberance (arrowhead) and mastoid process (arrow).

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  Fig. 2 Anterior-posterior fluoroscopic view of atlanto-occipital joint. (A) Before contrast media injection, bilateral atlanto-occipital joints (arrow) and atlanto-axial joints (arrowhead) are seen. (B) After contrast media injection, needle placement (black arrow) and spreading to the atlanto-occipital joint (asterix) are clearly visualized.

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