Dorsal and transoral injection therapy of C1/C2 arthritis

Patients with a rheumatic affection of the C1/C2 joints frequently complain of occipitocervical pain. Often the early loss of rotation is a handicap in daily life. In case of instability, operative fusion of C1/C2 is the therapy of choice. Cervicogenic headache may also be caused by osteoarthritic changes of the atlantoaxial joints. We investigated the effect of intraarticular corticoid injections into the arthritic C1/C2 joints in 30 patients. The injections were performed under CT control in local anaesthesia. We found a marked decrease of pain in 27 and an increased cervical function in 26 patients. The improvement lastet from three months to six years. No complications were observed. Based on our experience with more than 60 injections until now we conclude that the dorsal CT-guided intraarticular corticosteroid injection therapy of the atlantoaxial joints is a helpful method to decrease occipital and upper neck pain. It may possibly postpone an operative fusion in patients with painful arthritic affection of the C1/C2 joints without major instability. Patients with highly active rheumatoid arthritis also present a high risk of an acute or progressive impairment of their neurological status until sudden death. We report on eight patients with progressive symptoms of neurologic deficit and cervical myelopathy caused by a voluminous peridental synovitis with anterior compression of the spinal cord. This was demonstrated by MRI. As an immediate therapy we performed a transoral CT guided corticoid injection into the peri-/retrodental synovitis under general anaesthesia. As result we saw a rapid recovery of the neurological deficits and an impressive reduction of the peridental synovitis at the MRI control. We conclude that this injection technique can be recommended as an emergency therapy in such patients. This injection may also decrease the high risk of an emergency operative treatment under similar circumstances.