Table 12

Clinical studies evaluating AA joint injections

Author, yearPatient populationDesignResultsComments
Bogduk and Marsland, 1988824 consecutive pts who underwent cervical injections for head and neck pain, 4 of whom received AA injections with LA and steroidRetrospective study1 of 4 (25%) pts obtained pain relief from AA joint injection for 2 monthsUsed a fluoroscopically-guided posterior approach.
Pts had also trialed other cervical injections.
No reported adverse events
Lamer, 19911702 pts with cervical spine OA and ear pain provoked with head turning received AA joint injection with LA and steroidCase seriesBoth pts had pain relief following injectionUsed a fluoroscopically-guided posterior approach.
Injectate volumes not noted.
Duration of pain relief not reported
Chevrot et al 1995160100 pts (osteoarthritis, rheumatoid arthritis, ankylosing spondylarthritis, and diverse conditions) who received AA joint injections with LA and steroidRetrospective study18 (60%) of first 30 pts showed clinical improvement (duration of follow-up 6 months to 3 years)Used a fluoroscopically-guided posterior oblique approach.
One accidental vertebral artery puncture without clinically significant sequelae
Glemarac et al 200017226 pts with either mechanical (n=16) or inflammatory disorders (n=10) who received AA joint injections with steroid (no LA)Retrospective study69.3% responder rate with mean pain score reduction of 52.3% and mean duration of pain relief 8.1 monthsUsed a fluoroscopically-guided posterior approach.
Those with inflammatory conditions responded better than those with mechanical disorders. One case of moderately severe hypertension following injection
Aprill et al 2002534 pts with occipital pain and clinical features suggestive of AA joint origin received AA injection with LA and steroidProspective observational study21 of 34 (62%) pts obtained complete pain relief for at least the duration of action of LAUsed a fluoroscopically-guided posterior approach.
Duration of response not assessed. Clinical features did not predict positive response
Narouze et al 20076232 pts with clinical features suggestive of AA joint pain who received AA injection with LA and steroidRetrospective study15 of 32 (47%) pts had complete pain relief for the duration of action of LA, 26 of 32 (81%) had ≥50% improvement sustained at 3 monthsUsed a fluoroscopically-guided posterior approach.
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 201016731 pts with suspected cervicogenic headache who received AA joint, C2 and C3 dorsal rami, and C2–3 facet joint injection with LA and steroidRetrospective study28 of 31 (90%) pts had >50% pain relief with an average duration of 21.7 daysUsed 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 201716372 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 post-procedural adverse events resolved within 3 months.
Pain outcomes not reported
Hetta et al 201917360 pts with rheumatoid arthritis and AA joint pain received AA joint injection with LA and steroid or LA and salineRandomized controlledLA+steroid injection > LA-only injection through 3-month follow-up for pain and function, with improvement in imaging findings not observed in LA-only groupFluoroscopically-guided
posterior approach.
Permitted continued use of disease-modifying agents and oral NSAIDs for breakthrough pain
Kuklo et al 200616914 pts with AA joint pain received AA joint injection ‘via a standard technique’ with LA+steroids – no specifics providedRetrospective11 of 14 (79%) pts treated ‘successfully’ with 1–4 injections over the study period with significant pain relief. 3 refused injections, 3 had no relief from multiple injections, 3 had temporary relief from injections and went on to C1–2 fusion surgeryNo discussion on how ‘significant’ relief was defined
  • AA, atlanto–axial; LA, local anesthetic; NSAIDs, non-steroidal anti-inflammatory drugs; OA, osteoarthritis.