Avulsion of nerve rootlets with the Cuatico needle during Pantopaque removal after myelography

Three cases of histologically proven nerve root avulsion during Pantopaque removal with a Cuatico needle are described. While use of such multihole needles poses some risk to patients, we feel the advantages outweigh the disadvantages, particularly when a large volume of Pantopaque has to be removed. To minimize the possibility of nerve root avulsion, we recommend minimal manipulation of the needle and cannula during Pantopaque removal, use of gentle suction, termination of suction and injection of cerebrospinal fluid if pain occurs, and slow withdrawal of the cannula and stylet.