Anatomical and Technical Considerations of CT-Guided C1-C2 Lateral Joint Injections: Technique, Pitfalls, and Risks

Cervicogenic headaches, often originating from the upper cervical spine, represent a significant chronic pain condition. The C1-C2 joint, comprising synovial-lined lateral mass articulations and a pivot joint, is a common pain generator. Understanding the intricate anatomy, including the important anatomical adjacencies, innervation, and pathology of these joints, is crucial for effective intervention. This review highlights the importance of preprocedural evaluation, patient positioning, and CT-guided injection technique to minimize complications. The benefits of CT over fluoroscopic guidance for these procedures are also examined, providing a step-by-step guide to ensure accurate and safe needle placement and injection. Additionally, this manuscript reviews potential risks such as intravascular injection and nerve damage, offering strategies to mitigate these risks. This comprehensive analysis aims to enhance the understanding and execution of C1-C2 joint injections, ultimately improving patient outcomes. Moreover, this review demonstrates the effectiveness and safety of the C1-2 joint injections under CT guidance.