Removal of water-soluble contrast media after cervical myelography using cervical injection.

The development of thin-section high-resolution computed tomography (CT) has resulted in increased use of postmyelogram CT for the diagnosis of cervical disk disease. Complications of myelography appear to be related to the dose and the amount of intracranial spillage. Postmyelogram and preCT removal of water-soluble contrast material decreases the total dose of contrast material without compromising either study. We developed a method for safe and efficient removal of some of the contrast material from the cervical subarachnoid space. Our method permits immediate postmyelography CT for evaluation of disk disease, cord tumor, or metastatic disease without increased morbidity. This method also allows us to use water-soluble contrast material above the level of a cervical or high thoracic block without fear of adverse reactions and does not preclude the immediate use of contrast material introduced via lumbar puncture to outline the lower margin of the block. Complications associated with metrizamide (headache, nausea, emesis, hallucinations, photophobia, psychic disturbances, generalized seizures, motor deficits, and visual disorders) develop within 4-6 hr after myelography and coincide with CT demonstration of penetration into the brain and spinal cord [1-6] . Cervical myelograms have a greater incidence of complications than do lumbar myelograms because lumbar procedures keep contrast material away from the brain and metrizamide is absorbed while in a caudal location (half-life in the subarachnoid space is 4 hr) [7]. It has been reported that 66% of contrast material can be recovered by aspiration after lumbar myelography [8] . We believe a significant amount of the contrast material can also be retrieved after cervical myelography using the direct cervical approach, thus decreasing the concentration contacting the brain .