Table 12.
Clinical studies evaluating AA joint injections
| Author, year | Patient population | Design | Results | Comments |
| Bogduk and Marsland, 19888 | 24 consecutive pts who underwent cervical injections for head and neck pain, 4 of whom received AA injections with LA and steroid | Retrospective study | 1 of 4 (25%) pts obtained pain relief from AA joint injection for 2 months | Used a fluoroscopically-guided posterior
approach. Pts had also trialed other cervical injections. No reported adverse events |
| Lamer, 1991170 | 2 pts with cervical spine OA and ear pain provoked with head turning received AA joint injection with LA and steroid | Case series | Both pts had pain relief following injection | Used a fluoroscopically-guided posterior
approach. Injectate volumes not noted. Duration of pain relief not reported |
| Chevrot et al 1995160 | 100 pts (osteoarthritis, rheumatoid arthritis, ankylosing spondylarthritis, and diverse conditions) who received AA joint injections with LA and steroid | Retrospective study | 18 (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 2000172 | 26 pts with either mechanical (n=16) or inflammatory disorders (n=10) who received AA joint injections with steroid (no LA) | Retrospective study | 69.3% responder rate with mean pain score reduction of 52.3% and mean duration of pain relief 8.1 months | Used 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 20025 | 34 pts with occipital pain and clinical features suggestive of AA joint origin received AA injection with LA and steroid | Prospective observational study | 21 of 34 (62%) pts obtained complete pain relief for at least the duration of action of LA | Used a fluoroscopically-guided posterior
approach. Duration of response not assessed. Clinical features did not predict positive response |
| Narouze et al 200762 | 32 pts with clinical features suggestive of AA joint pain who received AA injection with LA and steroid | Retrospective study | 15 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 months | Used 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 2010167 | 31 pts with suspected cervicogenic headache who received AA joint, C2 and C3 dorsal rami, and C2–3 facet joint injection with LA and steroid | Retrospective study | 28 of 31 (90%) pts had >50% pain relief with an average duration of 21.7 days | Used 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 2017163 | 72 pts who received AA joint injections with LA and steroid | Retrospective study | Adverse 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 2019173 | 60 pts with rheumatoid arthritis and AA joint pain received AA joint injection with LA and steroid or LA and saline | Randomized controlled | LA+steroid injection > LA-only injection through 3-month follow-up for pain and function, with improvement in imaging findings not observed in LA-only group | Fluoroscopically-guided posterior approach. Permitted continued use of disease-modifying agents and oral NSAIDs for breakthrough pain |
| Kuklo et al 2006169 | 14 pts with AA joint pain received AA joint injection ‘via a standard technique’ with LA+steroids – no specifics provided | Retrospective | 11 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 surgery | No discussion on how ‘significant’ relief was defined |
AA, atlanto–axial; LA, local anesthetic; NSAIDs, non-steroidal anti-inflammatory drugs; OA, osteoarthritis.