(a) patient positioning, (b) sterile cover, (d) puncture, (c) MPR CT target correspondance
Indication: Pseudo Arnold’s Neuralgia in the case of atlas-axis spondylosis (frequent)

Target:

  • -Posterior aspect of the C1-C2 facet joint.

Procedure:

  • -Patient is placed prone on the CT table
  • -Axial scan from C0 - C3 for targeting and vertebral artery delineation (i.v. contrast is optional)
  • -Vertebral artery delineation
  • -Paramedial posterior puncture with a 25 gauge Spinal Needle
  • -CT-fluoroscopic guidance for fast and correct needle tip placement at the level of the C1-C2 facet joint
  • -Steroid injection

Danger:

  • -Vertebral artery puncture : CT fluoroscopic guidance enables avoiding the artery in all cases. Always stay medial to the lateral border of the bony facet and below the artery.
  • -Dural sac perforation: always stay lateral to the medial border of the facet joint.