Lateral C1-2 puncture for myelography: posterior approach

Area of Science:

• Neurosurgery
• Radiology
• Anatomy

Background:

• Cervical myelography is crucial for diagnosing spinal pathologies.
• Percutaneous radiofrequency cervical cordotomy is an established neurosurgical procedure.
• Anatomical variations of vertebral arteries pose risks during cervical interventions.

Purpose of the Study:

• To describe a modified lateral C1-2 puncture approach for cervical myelography.
• To enhance the safety of the C1-2 puncture technique by avoiding vascular structures.
• To adapt a neurosurgical approach for diagnostic imaging.

Main Methods:

• Modification of the standard percutaneous radiofrequency cervical cordotomy technique.
• Utilizing a lateral C1-2 puncture approach.
• Precise needle placement within the posterior one third of the neural canal at the C1-2 level.

Main Results:

• The modified technique successfully achieves C1-2 puncture for myelography.
• Posterior needle placement effectively avoids anomalous vertebral artery branches.
• Demonstrates a safer alternative to anterior needle placement in the neural canal.

Conclusions:

• The modified lateral C1-2 puncture approach offers a safer method for cervical myelography.
• Posterior needle positioning is critical for preventing vertebral artery injury.
• This technique is a valuable modification for neuroimaging of the upper cervical spine.