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Are C1–2 Punctures for Routine Cervical Myelography below the Standard of Care?

Are C1–2 Punctures for Routine Cervical Myelography below the Standard of Care? BACKGROUND AND PURPOSE: Recently, the performance of C1–2 punctures for cervical myelography was challenged in a medicolegal proceeding as being below the standard of care. We sought to examine current neuroradiologic practices and opinions on the technique. MATERIALS AND METHODS: An 11-question survey was sent to 120 program directors of neuroradiology via e-mail links regarding cervical myelography using a C1–2 puncture. Reminders were sent during a 2-month period before data were finalized. RESULTS: Eighty-five of 120 (71%) surveys were returned. In the previous year, 14.3% (12/85) of institutions had not performed a C1–2 puncture. Thirty-eight percent (32/85) had performed ≥6 in the same period. Seventy-nine percent (54/68 responding) favored a lumbar approach to cervical myelography, with 6% (4/68) having a predilection for a C1–2 puncture. Ninety-five percent (76/80 responding) thought that performing a C1–2 puncture for cervical myelography reflected the standard of care. Every institution except 1 had staff with expertise to perform C1–2 punctures, and 73% of the institutions teach their fellows the procedure. Ninety-three percent (78/84) of programs would perform a C1–2 puncture for thoracolumbar pathology if MR imaging was contraindicated and there was a contraindication such as a local wound infection precluding a lumbar puncture. Indications for a C1-2 approach included severe lumbar spinal stenosis, infection in the lumbar region, upper limit of the block to be delineated, technical issues preventing lumbar puncture, and the best assessment of the cervical region for myelographic films. CONCLUSIONS: C1–2 puncture for cervical myelography, though currently not the most frequently performed method at most institutions, continues to be practiced and is considered within the standard of care by most neuroradiology programs across the country. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Are C1–2 Punctures for Routine Cervical Myelography below the Standard of Care?

Yousem, D.M.; Gujar, S.K.
American Journal of Neuroradiology , Volume 30 (7): 1360 – Aug 1, 2009
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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2009 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A1594
pmid
19369600
Publisher site
See Article on Publisher Site

Abstract

BACKGROUND AND PURPOSE: Recently, the performance of C1–2 punctures for cervical myelography was challenged in a medicolegal proceeding as being below the standard of care. We sought to examine current neuroradiologic practices and opinions on the technique. MATERIALS AND METHODS: An 11-question survey was sent to 120 program directors of neuroradiology via e-mail links regarding cervical myelography using a C1–2 puncture. Reminders were sent during a 2-month period before data were finalized. RESULTS: Eighty-five of 120 (71%) surveys were returned. In the previous year, 14.3% (12/85) of institutions had not performed a C1–2 puncture. Thirty-eight percent (32/85) had performed ≥6 in the same period. Seventy-nine percent (54/68 responding) favored a lumbar approach to cervical myelography, with 6% (4/68) having a predilection for a C1–2 puncture. Ninety-five percent (76/80 responding) thought that performing a C1–2 puncture for cervical myelography reflected the standard of care. Every institution except 1 had staff with expertise to perform C1–2 punctures, and 73% of the institutions teach their fellows the procedure. Ninety-three percent (78/84) of programs would perform a C1–2 puncture for thoracolumbar pathology if MR imaging was contraindicated and there was a contraindication such as a local wound infection precluding a lumbar puncture. Indications for a C1-2 approach included severe lumbar spinal stenosis, infection in the lumbar region, upper limit of the block to be delineated, technical issues preventing lumbar puncture, and the best assessment of the cervical region for myelographic films. CONCLUSIONS: C1–2 puncture for cervical myelography, though currently not the most frequently performed method at most institutions, continues to be practiced and is considered within the standard of care by most neuroradiology programs across the country.

Journal

American Journal of Neuroradiology – American Journal of Neuroradiology

Published: Aug 1, 2009

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