Guidelines for cervical myelography: lumbar versus cervical puncture technique

Area of Science:

• Neuroradiology
• Medical Imaging
• Neurology

Background:

• Cervical myelography is an imaging procedure used to visualize the spinal cord and surrounding structures in the neck.
• Two primary methods for contrast administration exist: direct cervical puncture and lumbar puncture with contrast run-up.
• Non-ionic contrast media, such as iopamidol, are commonly employed in myelography.

Purpose of the Study:

• To prospectively compare the safety and efficacy of direct cervical puncture versus lumbar puncture with contrast run-up for cervical myelography.
• To evaluate the incidence of side effects and diagnostic image quality between the two techniques.
• To assess the amount of contrast medium entering the skull and its correlation with EEG abnormalities.

Main Methods:

• A prospective study involving 300 patients undergoing cervical myelography with iopamidol.
• 130 patients received contrast via direct cervical puncture, and 170 via lumbar puncture with run-up.
• A subgroup of 80 patients underwent pre- and post-myelography EEG examinations and skull films to quantify intracranial contrast.

Main Results:

• Both techniques yielded equivalent diagnostic image quality.
• The lumbar puncture with run-up technique resulted in no increase in side effects compared to direct puncture.
• Direct cervical puncture led to significantly more contrast entering the skull and a higher incidence of EEG abnormalities.

Conclusions:

• Lumbar puncture with contrast run-up is a safer method for cervical myelography, reducing intracranial spill and potential cortical irritation.
• The study supports the use of lumbar puncture technique for cervical myelography, particularly when performed by experienced neuroradiologists.
• Anticonvulsant premedication with phenytoin is recommended for all patients undergoing cervical myelography with iopamidol due to observed EEG changes.