Guidelines for cervical myelography: lumbar versus cervical puncture technique.

Cervical myelography may be performed with non-ionic contrast media either by direct cervical puncture or by lumbar puncture with run-up of the contrast medium. In this prospective study of 300 cervical myelograms using iopamidol (130 by direct puncture and 170 by lumbar puncture), we have shown that the run-up technique causes no more side effects than direct puncture technique and films of equivalent diagnostic quality are obtained. A sub-group of 80 patients had EEG examinations before and after myelography, plus a lateral skull film taken at the end of the myelogram to assess the amount of contrast medium that had entered the skull. More EEG abnormalities were found in those patients examined by direct puncture and significantly more contrast medium had entered the skull in this group. Run-up myelography therefore results in less intracranial spill and so less potential for cortical irritation. In view of the EEG abnormalities, anticonvulsant premedication is discussed, and we now give phenytoin to all patients having cervical myelography with iopamidol. We consider that cervical myelography can be adequately and more safely performed by lumbar puncture technique but, to optimise patient safety, should be performed by a radiologist experienced in neuroradiology.