Abstract：
BACKGROUND: Neck pain and headaches can arise from the lateral atlanto-axial joint (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.
OBJECTIVE: The objective was to describe and test a new technique for accessing the LAA joint that avoids structures that lie behind the joint.
METHODS: The 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.
CONCLUSIONS: In 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.
OBJECTIVE: The objective was to describe and test a new technique for accessing the LAA joint that avoids structures that lie behind the joint.
METHODS: The 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.
CONCLUSIONS: In 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.
摘要：
背景：颈痛和头痛可由外侧寰枢关节（LAA关节）引起。这种疼痛可以通过关节内注射局部麻醉药来诊断。一种广泛使用的技术可以进入外侧寰枢关节，但是这种方法可能很危险，因为椎动脉很接近，硬脑膜囊,和C2脊神经和背根神经节。
目的：目的是描述和测试一种用于进入左心耳关节的新技术，该技术避免了关节后面的结构。
方法：描述了新技术，并测试了10例单侧枕下疼痛患者的耐受性，和LAA关节上的压痛，以及SPECTCT显示的LAA关节病的证据。该技术需要沿着与C2层的背表面相切的轨迹插入针。它涉及获得C2层和C2椎弓根的下降视图。
结论：在所有情况下，C2椎弓根很容易识别，并允许针头在关节后面的神经血管结构下方渐近通过。C2层的触觉反应提供了有关LAA关节尾端针深度的重要反馈。
目的：目的是描述和测试一种用于进入左心耳关节的新技术，该技术避免了关节后面的结构。
方法：描述了新技术，并测试了10例单侧枕下疼痛患者的耐受性，和LAA关节上的压痛，以及SPECTCT显示的LAA关节病的证据。该技术需要沿着与C2层的背表面相切的轨迹插入针。它涉及获得C2层和C2椎弓根的下降视图。
结论：在所有情况下，C2椎弓根很容易识别，并允许针头在关节后面的神经血管结构下方渐近通过。C2层的触觉反应提供了有关LAA关节尾端针深度的重要反馈。
