From the Research
For C0-C1 facet joint injections, a 25-gauge or 26-gauge needle is typically recommended. These small-diameter needles provide the optimal balance between control and precision while minimizing patient discomfort during this delicate procedure. The C0-C1 facet joint (atlantooccipital joint) is a challenging target due to its deep location and proximity to critical neurovascular structures, making needle selection particularly important. When performing this injection, the needle is typically advanced under fluoroscopic guidance to ensure accurate placement, as recommended by the American Society of Interventional Pain Physicians (ASIPP) guidelines 1. The procedure usually involves injecting a mixture of local anesthetic (such as lidocaine or bupivacaine) and corticosteroid (like methylprednisolone or triamcinolone) into the joint space. The thin gauge needle helps reduce the risk of trauma to surrounding structures while still allowing for adequate delivery of the injectate.
Some key points to consider when performing C0-C1 facet joint injections include:
- The use of fluoroscopic guidance to ensure accurate placement of the needle 1
- The selection of a suitable needle gauge, with 25-gauge or 26-gauge needles being commonly recommended
- The importance of proper sterilization techniques to minimize the risk of infection
- The potential use of ultrasound guidance as an alternative to fluoroscopy, as described in a recent study 2
- The need for careful approach and high degree of skill when performing the injection, as highlighted in the ASIPP guidelines 1
It's worth noting that the evidence for the use of specific needle gauges for C0-C1 facet joint injections is limited, and the recommendation for a 25-gauge or 26-gauge needle is based on general principles of needle selection and the need to balance control and precision with patient comfort. However, the most recent and highest quality study on the topic of facet joint injections, published in 2022, provides guidance on the use of ultrasound guidance for cervical facet joint injections, which may be relevant to C0-C1 facet joint injections 2.