Atlanto-Occipital and Atlanto-Axial Joint Injections


The atlanto-occipital and atlanto-axial joints are joints in the spine that connect the cervical region to the base of the skull. The atlanto-occipital and atlanto-axial joints are common causes of neck pain and stiffness due to occurrences like acceleration/deceleration injuries (e.g. whiplash) and arthritic damage. Patients with conditions of the atlanto-occipital and atlanto-axial joints frequently present with neck pain, stiffness, and decreased range of motion in all three planes for flexion, extension, and lateral rotation.

Atlanto-occipital and atlanto-axial injections are procedures used for both diagnostic therapeutic purposes. The procedure is performed under fluoroscopic guidance and involves the placement of a small needle in the atlanto-occipital or atlanto-axial joint. A small aliquot of medication – either local anesthetic or corticosteroid – is then injected. For a diagnostic procedure, local anesthetic is administered and the patient’s response is carefully noted. If the patient reports greater than 80% pain reduction, then the atlanto-occipital or atlanto-axial joint is diagnosed as the source of pain. Typically, a second injection is performed to confirm the results of the first diagnostic injection. For a therapeutic procedure, a small amount of corticosteroid is injected, leading to anti-inflammatory and analgesic effects.


Atlanto-occipital and atlanto-axial joint injections are indicated for the following:

  • Atlanto-occipital or atlanto-axial joint pathologies, which present as deep pain in the suboccipital region
  • Flexion/extension injuries, such as whiplash
  • Cervicogenic headaches that impair function
  • Persistent upper cervical pain requiring excessive opioid usage
  • Persistent occipital neuralgia that does not respond to occipital nerve blocks