Wilkinson A G, Sellar R J
Department of Neuroradiology, Western General Hospital, Edinburgh.
Clin Radiol. 1991 Nov;44(5):338-41. doi: 10.1016/s0009-9260(05)81272-3.
A randomized prospective trial of 26 G versus 22 G spinal needles was performed in 284 consecutive patients referred for myelography, during which contrast medium was introduced by lumbar puncture. Use of the fine (26 G) gauge needle resulted in a significant decrease in moderately or severely painful needle placements and moderate, severe or postural headaches following myelography. The incidence of other side effects was not significantly influenced by needle size. The incidence of headaches and other side effects was significantly higher in female patients. Back pain, the commonest side effect, was significantly more common in patients who had normal lumbar myelograms than in those in whom lumbar root compression was demonstrated. The incidence of neck stiffness was significantly higher following cervicothoracic myelograms than lumbar myelograms but there was no significant difference in the incidence of other side effects. The use of 4.5 g instead of 3.0 g of iodine resulted in no increase in symptoms. The experience of the operator had no significant effect on the incidence of side effects. Some side effects of myelography appear to be due mainly to cerebrospinal fluid leakage at the site of puncture and are strongly influenced by psychological factors.
对284例连续接受脊髓造影检查的患者进行了一项随机前瞻性试验，比较26G与22G脊髓穿刺针。脊髓造影检查期间，通过腰椎穿刺注入造影剂。使用细（26G）规格的穿刺针可显著减少穿刺时中度或重度疼痛以及脊髓造影检查后中度、重度或体位性头痛的发生。穿刺针尺寸对其他副作用的发生率无显著影响。女性患者头痛及其他副作用的发生率显著更高。背痛是最常见的副作用，腰椎脊髓造影正常的患者比显示腰椎神经根受压的患者背痛更为常见。颈胸段脊髓造影后颈部僵硬的发生率显著高于腰椎脊髓造影，但其他副作用的发生率无显著差异。使用4.5g而非3.0g碘剂并未导致症状增加。操作者的经验对副作用的发生率无显著影响。脊髓造影检查的一些副作用似乎主要是由于穿刺部位脑脊液漏出，并且受心理因素的强烈影响。
