Cervical Diskography Performed with a "Prong Deflector" for Improved Access to the Cervical Disk Spaces
Walter S. Bartynskia,
Stephen Z. Grahovaca and
William E. Rothfusa
a Department of Radiology, Division of Neuroradiology, University of Pittsburgh, Pittsburgh, PA. S.Z.G. is currently at Christiana Hospital, Newark, DE
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FIG 1. The prong deflector tool has an aluminum handle for operator grasp and control attached to a plastic covered steel two tine active end that is shaped to resemble the operator’s fingertips with slight tine curvature and a 3–3.5-cm gap.
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FIG 2. Example of thyroid cartilage displacement visualized at fluoroscopy during cervical diskography in a 49-year-old man with severe neck pain radiating to his left arm and shoulder.
A, The prong deflector (arrow) lies adjacent to the right lateral margin of the thyroid cartilage (arrowheads). The cartilage is difficult to visualize as it overlies the disk spaces, uncinate processes and Lushka’s joints on the patients right.
B, With displacement of the thyroid cartilage toward the midline, the lateral margin of the cartilage is now visible (arrowheads) and can be seen, no longer overlying the lateral aspect of the disk space and no longer overlying the intended target.
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FIG 3. Operator insertion of the 25-gauge needle by using the prong deflector for neck tissue control.
A, The prong deflector maintains control of the neck structures while the needle is inserted (arrow). Fluoroscopic inspection of the needle position and trajectory can be obtained without direct operator exposure of the central beam.
B, Example of fluoroscopic visualization of needle insertion during cervical diskography with assistance of the prong deflector tool in a 44-year-old man with persistent neck pain radiating to his posterior left shoulder. The prong deflector is being used during needle insertion of the C5–6 disk space with thyroid cartilage displaced medial to the prong deflector tines (white arrow) and clear access to the disk space established (black arrowhead).
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FIG 4. Postdiskogram CT image in a 46-year-old woman with unrelenting neck pain radiating down both arms that demonstrates close proximity of the carotid artery and neurovascular sheath to thyroid cartilage (arrow) as is typically seen in most patients.
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FIG 5. Postdiskogram CT images in the 48-year-old man with chronic neck and right arm pain where difficulty was encountered in access to the C4–5 disk space despite attempted displacement of the larynx with the prong deflector tool. The hyoid bone is wide and the anterior aspect of the C4 vertebral body (black arrow) projects deeply into the gap between the hyoid cornua (arrowheads), preventing displacement of the hyoid and thyroid cartilages across the midline. Without hyoid and thyroid cartilage displacement, clear and safe access to the disk space could not be obtained.
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