Radiology, Vol 146, 401-408, Copyright © 1983 by Radiological Society of North America
Lateral C1-2 puncture for cervical myelography. Part III: Historical, anatomic, and technical considerations
WW Orrison, OP Eldevik and JF Sackett
Three significantly different lateral approaches to the cervical
subarachnoid space (anterior, midplane, and posterior needle positions)
have been previously described for cordotomy and myelography. Experimental
lateral C1-2 punctures were performed by each of these three methods in
anatomic specimens, cadaver models with reconstituted cerebrospinal fluid
pressures, a patient with cerebral death, and to a limited degree in
patients undergoing routine cervical myelography. In the cervical region
the dura is pushed ahead of the needle, forming a "tent" over the needle
tip during C1-2 puncture; the needle projects several millimeters into the
spinal canal before penetrating the dura, regardless of the method of entry
or needle diameter. The extent of this tenting phenomenon and its
relationship to the spinal cord are significantly affected by the needle
diameter and position. A posterior technique for lateral C1-2 puncture is
described.
