[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-441103-105":59,"doc-detail-441103-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","fluoroscopic-c2-selective-nerve-root-block-enabled-with-ct-angiogram","Fluoroscopic C2 selective nerve root block enabled with CT angiogram","","Case report describing how vertebral artery (VA) anatomy variability near the C1–C2 region can create risk during upper cervical instrumentation and C2 nerve blocks, especially in patients with altered posterior C1 anatomy. For a patient with prior cerebellar astrocytoma and occipital neuralgia, computed tomography angiography (CTA) was used to precisely locate the VA. After confirming the VA was not near the lateral atlanto-axial joint, the C2 nerve block was completed without complications, resolving occipital pain. CTA proved critical for pre-procedural planning when vascular anatomy is uncertain.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/fluoroscopic-c2-selective-nerve-root-block-enabled-with-ct-angiogram/441103/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/fluoroscopic-c2-selective-nerve-root-block-enabled-with-ct-angiogram/441103.png","ImageObject",300,407,{"name":92,"@type":93},"Theodore","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is C2 nerve block challenging in some patients?","Question",{"text":112,"@type":113},"Because the vertebral artery can run close laterally near the C2 root and the dural sac can be medially, while anatomic variability may increase the risk despite following best-practice guidelines.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What was the purpose of using CT angiography (CTA) in the case?",{"text":117,"@type":113},"CTA was used to describe and confirm the precise location of the vertebral artery for planning the C2 selective nerve root block safely.",{"name":119,"@type":110,"acceptedAnswer":120},"What was the outcome after the C2 nerve block?",{"text":121,"@type":113},"After determining that the VA was not in proximity to the lateral atlanto-axial joint, the C2 nerve block was completed uneventfully with resolution of occipital pain.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},441103,1790779742,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39,"preview_page_count":4},7971461740886,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Interventional Pain Medicine 5 (2026) 100721  \nContents lists available at ScienceDirect  \nInterventional Pain Medicine  \njournal [homepage:](homepage: www.journals.elsevier.com/interventional-pain-medicine)[ www.journals.elsevier.com/interventional-pain-medicine](homepage: www.journals.elsevier.com/interventional-pain-medicine)  \n| Fluoroscopic C2 selective nerve root block enabled with CT angiogram |  |  | |\n| --- | --- | --- | --- |\n| Christopher Zarembinski * , J. Patrick Johnson\u003Cbr>The Pain Center, Department of Anesthesiology, Cedars Sinai Medical Center, 444 S San Vicente Blvd, Suite 1101, Los Angeles, USA |  |  |  |\n| A R T I C L E I N F O |  | A B S T R A C T |  |\n| Keywords:\u003Cbr>Vertebral artery\u003Cbr>C2 nerve root block\u003Cbr>Lateral atlanto-axial joint\u003Cbr>C1 posterior arch\u003Cbr>Computed tomography angiography Cerebellar astrocytoma |  | Introduction: The anatomy of the vertebral artery (VA) can be variable around the C1 and C2 vertebrae, which can pose risk during cervical spine instrumentation and pain blocks. A patient with prior cerebellar astrocytoma required a C2 nerve root block for treatment of occipital neuralgia. Precise location of the VA was questioned due to previous posterior C1 arch excision.\u003Cbr>Case: The objective was to describe the utility of CT angiogram (CTA) in describing VA location in planning the C2 nerve root block. Once determined that the VA was not in proximity of the lateral atlantoaxial joint (LAA), then the C2 nerve block was completed uneventfully with resolution of occipital pain.\u003Cbr>Conclusions: The CTA was critical in determining VA location in advance of C2 nerve root block, and can be used with regularity when vascular anatomy is questioned. |  |\n\n1. Introduction  \nThe C2 nerve can be the cause of occipital neuralgia. Occipital neuralgia is characterized by paroxysmal burning and lancinating pain in the distribution of the greater, lesser, or third occipital nerves. Several etiologies have been identified, including compression of the C2 nerve root [1]. The effectiveness ofC2 nerve block followed by radiofrequency ablation has been described [2]. Moreover, surgical interventions such as C2 dorsal root ganglionectomy have been effective in providing long term pain relief for patients with medically refractory occipital neuralgia [3].  \nThe complex pathway of the vertebral artery (VA) around the atlas (C1) and axis (C2) is crucial for understanding surgical approaches and avoiding vascular injury during procedures involving the upper cervical spine and craniocervical junction. From the transverse foramen of C2, the VA ascends vertically to enter the transverse foramen of C1. After exiting the transverse foramen of C1, the VA courses horizontally over the posterior arch of C1 within the groove known as the sulcus arteriae vertebralis. Following this horizontal course, the VA then turns medially and ascends obliquely to pierce the dura mater and enters the cranial cavity through the foramen magnum (Figs. 1, 3 and 4).  \nAccessing the C2 nerve root requires care because of the proximity of the vertebral artery laterally, and the dural sac medially. Anatomic variability places these structures at risk despite adhering to best practice guidelines [4]. Elgueta found that the vertebral artery coursed medially over the lateral quarter of the dorsal lateral atlantoaxial (LAA)  \njoint surface in 1 % of subjects [5]. McNabney and colleagues noted that with conventional needle trajectory, an anomalous vertebral artery could be encountered in 0.72 % of LAA joints injected, and emphasized the importance of pre-procedural review of imaging [6]. Curylo et al. performed a cadaveric study in 222 specimens and identified a 2.7 % incidence of tortuous VA course [7].  \nBiomechanical studies have shown that the excision of the C1 posterior arch increased the range of motion and stress on the LAA joint. Chen et al. demonstrated that removal of the C1 posterior arch resulted in increased LAA joint range of motion a","cbCaibZw2lmhQ1he","https://ap.wps.com/l/cbCaibZw2lmhQ1he","pdf",3700206,"English","# Introduction\n## Vertebral artery anatomy and variability at C1–C2\n## Occipital neuralgia and role of C2 nerve block\n## Importance of preoperative CTA for planning\n# Case and procedure rationale\n# Conclusion","[{\"question\":\"Why is C2 nerve block challenging in some patients?\",\"answer\":\"Because the vertebral artery can run close laterally near the C2 root and the dural sac can be medially, while anatomic variability may increase the risk despite following best-practice guidelines.\"},{\"question\":\"What was the purpose of using CT angiography (CTA) in the case?\",\"answer\":\"CTA was used to describe and confirm the precise location of the vertebral artery for planning the C2 selective nerve root block safely.\"},{\"question\":\"What was the outcome after the C2 nerve block?\",\"answer\":\"After determining that the VA was not in proximity to the lateral atlanto-axial joint, the C2 nerve block was completed uneventfully with resolution of occipital pain.\"}]","Fluoroscopic C2 selective nerve root block enabled with CT angiogram | PDF",1790694664]