An aid to C1-X2 percutaneous puncture

Abstract

Many investigators consider gas myelography the most reliable examination in patients with pathologic conditions in the spinal cord [1]. Gas myelogmaphy using the lateral C1-C2 puncture as reported by Rosomoff et al. [2] is the usual method performed, is safe, and is preferable to cistemnal puncture with its risk of medullary injury. The C1-C2 approach using C-arm fluomoscopy for guiding the needle insures proper placement and is the method used by Heinz and Goldman [3]. In circumstances where fluonoscopy is not available, C1-C2 percutaneous punctune can still be accomplished; however, multiple films for positioning the needle during the procedure are necessary for safety. We have developed a device which can be used to cleanly indicate the correct site for needle placement on a single scout film. This reduces the need for multiple punctures and unnecessary x-ray exposure. The basic design employs a grid of 14 gauge stainless steel wire measuring 5 cm x 8 cm. The grid spacing is 7.1 mm in its larger squares and 2.5 mm in the smaller areas. The grid may be slightly curved to fit the slope of the patient’s neck and is fitted with fiat metal tabs at each corner for use as tape-down points.