Myelography of spinal block from epidural tumor: a new approach.

Eleven patients with spinal canal block from metastatic epidural tumor, documented with Pantopague myelography, were given an additional injection of up to 5 cc of air. This technique forced contrast material past the block in 10 of 11 cases. It failed in one case in which symptoms had been present for 19 days. Air injection allowed visualization of more cephalad lesions and defined the superior extent of the initial obstructing lesion without the need for a lateral cervical or cisternal puncture. It caused transient discomfort but no neurologic deterioration. This technique is less painful, requires less patient cooperation, expedites localization, and does not require the special skills needed for cervical puncture.