Air Myelography for Demonstration of the Cervical Spinal Cord

Abstract

The Demonstration of the cerebral ventricles and the subarachnoid spinal pathways by the direct introduction of air was first recognized and applied as a diagnostic procedure by Wideroe (20) and Dandy (4). Bingel and Jacobaeus (11) pointed out the value of air injection by means of the lumbar route and succeeded in demonstrating blockage of the spinal pathways in the lumbar and lower thoracic areas. Reichert (17) and Brockbank (1) used air as a contrast medium to demonstrate intraspinal structures, following the use of air myelography in the lumbar area by Coggeshall and von Storch (3) and by Van Wagenen (19). The method was also utilized by Chamberlain and Young (2) in the study of spinal lesions, especially those in the lumbo-caudal sac. Recently the demonstration of intraspinal dermoid tumors has been accomplished by List (14). Previous investigators have noted the presence of air in the upper cervical region following encephalography and occasionally ventriculography and have utilized this observation in the examination of the spinal cord. Pendergrass, however, has pointed out that, while air has been utilized to outline the intraspinal structures, limited success has been obtained except in the cervical region (15). Here, as in the lumbo-caudal area, the boundaries of the subarachnoid space are sharply delineated by the air so that any change of configuration of the spinal canal appears in the roentgenogram. The demonstration of a lesion of the spinal cord may present a special problem when no block or diagnostic defect in the opaque myelographic medium is present. In the cervical area, where the lipiodol examination of the spinal pathways is difficult, this is particularly true. Here the position of the patient, the fragmentation of the lipiodol column, and the disconcerting escape of the opaque material into the cranial subarachnoid pathways make detection of small non-obstructing lesions very difficult. Stookey, Elsberg, Mixter and Barr, Ayer and Spurling have discussed examination of the lesions of the cervical cord following the use of lipiodol, As Hampton points out, some of these writers have not found roentgen examinations of the cervical area after lipiodol injection of much value. Recently an encephalomyelogram was seen suggesting enlargement of the cervical spinal cord. While Dyke and Davidoff (6), Dyke and Elsberg (10), and Pendergrass (15) have published illustrations of the cord following encephalography, no study of the normal roentgen anatomy could be found in the literature. It seemed necessary, therefore, for the sake of comparison, to determine the normal roentgen measurements of the cervical cord as seen in the lateral view following the injection of air into the lumbar subarachnoid spinal pathways (Fig. 1). For this reason, lateral views of the cervical area were made following routine encephalography and in some cases oblique views of the cervical and upper dorsal vertebrae were also obtained (Fig. 2).