C1 Posterior Arch Flare Point: A Useful Landmark for Fluoroscopically Guided C1–2 Puncture

Peckham, Miriam E.; Shah, Lubdha M.; Tsai, Alan C.; Quigley, Edward P.; Cramer, Justin A.; Hutchins, Troy A.

doi:10.3174/ajnr.a5706

Cited by 1 publication

(1 citation statement)

References 27 publications

(42 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is our preference to use the decubitus position because it maximizes access to the craniocervical junction region, especially in smaller children. The preferred skin-entry site is at C1-2 with the needle positioned about midway between the flare point 5 anteriorly that approximates the posterior border or the spinal cord and the spinal laminar line posteriorly that approximates the margin of the subarachnoid space (Fig 4). A 3.5-inch needle is used, and under continuous biplane fluoroscopic guidance, the needle tip is positioned in the midline, confirmed on the frontal projection.…”

Section: Cervical Puncture Techniquementioning

confidence: 99%

The Complex Spine in Children with Spinal Muscular Atrophy: The Transforaminal Approach—A Transformative Technique

Towbin

Schaefer

Kaye

et al. 2019

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: Spinal muscular atrophy, a genetic disease resulting in loss of motor function, presents from in utero to adulthood. Depending on progression and secondary scoliosis, spinal stabilization may be necessary. When planning intrathecal access in these patients, spinal anatomy is the most important factor. Therefore, when planning intrathecal nusinersen injections, we subdivided patients with spinal muscular atrophy into simple-versus-complex spine subgroups. Our purpose was to present our experience with our first 42 transforaminal intrathecal nusinersen injections. MATERIALS AND METHODS:We reviewed 31 consecutive patients with spinal muscular atrophy types 1-3 who presented for intrathecal nusinersen injections from March 2017 to September 2018. Nine children had complex spines (ie, spinal instrumentation and/or fusion) and required preprocedural imaging for route planning for subarachnoid space access via transforaminal or cervical approaches. RESULTS:A total of 164 intrathecal nusinersen injections were performed in 31 children 4 -226 months of age, with 100% technical success in accessing the subarachnoid space. Nine patients with complex spinal anatomy underwent 45 intrathecal nusinersen injections; 42 of 45 procedures were performed via a transforaminal approach with the remaining 3 via cervical techniques. There were no complications. CONCLUSIONS:Our initial experience has resulted in a protocol-driven approach based on simple or complex spinal anatomy. Patients with simple spines do not need preprocedural imaging or imaging-guided intrathecal nusinersen injections. In contrast, the complex spine subgroup requires preprocedural imaging for route planning and imaging guidance for therapy, with the primary approach being the transforaminal approach for intrathecal nusinersen injections.

show abstract

Section: Cervical Puncture Techniquementioning

confidence: 99%

The Complex Spine in Children with Spinal Muscular Atrophy: The Transforaminal Approach—A Transformative Technique

Towbin

Schaefer

Kaye

et al. 2019

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

C1 Posterior Arch Flare Point: A Useful Landmark for Fluoroscopically Guided C1–2 Puncture

Abstract: The C1 posterior arch flare point accurately approximates the dorsal spinal cord margin on myelography. Targeting between the flare point and the spinolaminar line, at the mid-C1-2 interspace, allows safe and optimal needle positioning.

Cited by 1 publication

References 27 publications

The Complex Spine in Children with Spinal Muscular Atrophy: The Transforaminal Approach—A Transformative Technique

The Complex Spine in Children with Spinal Muscular Atrophy: The Transforaminal Approach—A Transformative Technique

Contact Info

Product

Resources

About