Procedure Description
An atlantoaxial (C1-2) facet steroid injection is a minimally invasive procedure used to diagnose and treat pain originating from the facet joint between the first (C1) and second (C2) cervical vertebrae, also known as the atlantoaxial joint. This joint allows for a significant portion of head rotation and is susceptible to degeneration, inflammation, and arthritis.
During the procedure, a combination of local anesthetic and corticosteroid is injected directly into or around the C1-2 facet joint to reduce inflammation, numb the area, and interrupt pain signals.
Because the atlantoaxial region is highly delicate and located near critical neurovascular structures, this injection is performed using precise imaging guidance for maximum safety and accuracy.
What It Treats
C1-2 facet steroid injections are used to diagnose and/or treat:
Chronic upper neck pain
Occipital headaches or cervicogenic headaches
Post-traumatic neck pain involving the upper cervical spine
Atlantoaxial arthritis (including in patients with rheumatoid arthritis)
Mechanical pain worsened by head rotation or upper neck movement
Referred pain to the back of the head or behind the eyes
This procedure can be both diagnostic (to confirm the pain source) and therapeutic (to relieve pain).
How It Is Performed
You will lie on your back or stomach depending on the imaging approach.
The skin over the upper neck is cleansed and numbed with local anesthetic.
Under fluoroscopic (X-ray) or CT guidance, a thin needle is advanced toward the C1-C2 facet joint.
A small amount of contrast dye is injected to confirm needle placement.
A mixture of corticosteroid and local anesthetic is slowly injected into the joint or around the medial branch nerve innervating the joint.
The needle is removed, and a small bandage is applied.
The procedure usually takes 20–30 minutes and is done in an outpatient setting.
Pre-Procedure Instructions
Do not eat or drink for 6 hours prior if sedation is planned.
Continue routine medications unless instructed otherwise. Blood thinners may need to be paused several days beforehand—follow your provider’s guidance.
Inform your provider if you:
Are allergic to steroids, anesthetics, or contrast dye
Are pregnant or breastfeeding
Have a bleeding disorder, active infection, or uncontrolled medical condition
Arrange for someone to drive you home if sedation is used.
Wear comfortable clothing and avoid jewelry near the neck area.
What to Expect After the Procedure
Immediate numbness or relief may occur due to the local anesthetic.
Steroid effects may take 2–5 days to fully develop.
Pain relief can last from weeks to months, depending on the cause and severity of the inflammation.
You may experience mild soreness at the injection site or temporary increase in pain—this usually resolves within a few days.
Most patients return to normal activity the next day, avoiding strenuous exertion for 24 hours.
If the injection provides significant but temporary relief, your provider may discuss repeat injections or radiofrequency ablation (RFA) of the C2 medial branch for longer-term results.
Call your provider if you experience:
Fever, chills, or signs of infection
Increased neck pain, numbness, or difficulty swallowing
New or worsening neurological symptoms
Specialized Relief for Upper Neck and Head Pain
At Parkview Spine & Pain, we offer precision-guided C1-2 facet steroid injections to help patients suffering from refractory upper cervical spine pain or occipital headaches. If you’ve tried other therapies without success, this advanced, targeted approach may provide the relief you need.
👉 Schedule a consultation today to find out if an atlantoaxial injection is right for your neck or headache pain.