Lateral C1-2 puncture for cervical myelography. Part II: Recognition of improper injection of contrast material.

Abstract

The interpretation of cervical metrizamide myelography requires specific anatomic considerations, particularly when the lateral C1-2 puncture technique is employed. Fresh unfixed cervical spine specimens were injected with a mixture of metrizamide and methylene blue. Radiologic examinations of these specimens were compared with a retrospective analysis of 100 consecutive unselected cervical myelograms obtained by lateral C1-2 puncture during the years 1979-1980. Epidural, subdural, subpial, dentate ligament, and spinal cord injections may be encountered when the lateral C1-2 puncture for myelography is employed; possible artifacts from such injection are discussed.

3D T2 MR Imaging–Based Measurements of the Posterior Cervical Thecal Sac in Flexion and Extension for Cervical Puncture

“…To our knowledge, there are no prior studies that measure the size of the posterior upper cervical thecal sac in these various positions. Orrison et al 8 performed a postmortem study and found that the average posterior thecal sac size at C1-C2 in the neutral position was 4.3 mm, in a range similar to that of measurements obtained in our study. Most interesting, Orrison et al also showed up to 1 cm of tenting of the dura ahead of the needle in cervical puncture before CSF was seen in the hub.…”

“…[5][6][7] Measurements of the posterior cervical thecal sac are reported with x-ray myelography, with mention of a subjective change in dural configuration and lack of subjective movement of the cord at the C1-C2 level on flexion and extension. 8 Recently, thin-section MR imaging techniques have been used to assess cervical spinal canal dimensions in healthy volunteers. 9 To our knowledge, no study has confirmed that there is more space in the posterior thecal sac at C1-C2 with neck extension over flexion or with prone-versus-supine positioning.…”

Iatrogenic Brainstem Injury During Cerebellomedullary Cistern Puncture

“…In human patients, cervical myelography is performed through the C1-C2 intervertebral foramen using a lateral approach under fluoroscopy guidance. 11,12 Complications associated with this procedure include direct spinal cord damage, contrast injection in the epidural space or into the spinal cord, puncture between the occiput and C1, and puncture of the extradural vertebral venous plexus. 13,14 In humans, intramedullary contrast medium injection in the cervical spinal cord is associated with neck pain, hyperesthesia, arm weakness, and hypoalgesia in arms and/or face.…”

Subdural injection of myelographic contrast in two horses

“…Recent anatomical studies have shown that this space is created as a laceration of dura cells when subtle changes in the pressure balance between the subarachnoid space and dural or epidural layers occur (Frederickson 1991;Haines 1991). In human radiography, myelographic misinjection into the subdural space has long been recognised (Schultz and Brogdon 1962;Orrison et al 1983). In veterinary radiology, it was first described in 2 horses and one dog (Scrivani et al 1997).…”