C12 Puncture: A Safe, Efficacious, and Potentially Underused Technique

W.N. Gibbs; M.R. Skalski; P.E. Kim; J.L. Go; M. Law

View Article on Neurographics Website

Date of Activity Release: Feb. 1, 2017
Date of Activity Expiration: Feb. 1, 2020

Target Audience:
Intended for neuroradiologists and neuroradiology trainees with varying degrees of experience.

Learning Objectives:
Understand the key components of a safe C1–2 puncture, including proper technique, anatomy, and potential complications.

A C1–2 puncture for injection of myelographic contrast, CSF collection, or administration of intrathecal chemotherapy is much less frequently used now than in the past. This is partially due to increased use of MR imaging for spinal imaging and decreased use of myelography. However, there are contraindications to a lumbar approach, and, occasionally, a lumbar puncture fails, which requires a cervical approach to the subarachnoid space. Many neuroradiologists and trainees receive little practice in the technique and have the perception that the procedure is dangerous and difficult to perform. A careful review of the literature revealed that complications are few. This review described the history of the C1–2 approach, indications, technique, and relevant anatomy, and a review of the literature related to a procedure's complications. We concluded with a discussion of situations in which a C1–2 puncture is preferred by providing increased comfort and safety for select patient populations.

Commercial Support
No commercial support was received for this activity.

Credit Designation Statement

The American Society of Neuroradiology is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Society of Neuroradiology designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Method of Physician Participation:
Each participant will review the corresponding Neurographics article located at Upon completion, each physician will complete and pass a post-test with a score of at least 80% to receive a CME certificate.

All individuals in control of content have disclosed the following relevant financial relationships. All of these relationships were treated as a conflict of interest, and have been resolved (C7 SCS 6.1-6.2, 6.5)

Authors have no relevant financial relationships.





Barton Branstetter 

Editor in Chief

None, N/A

Adam Flanders

Deputy Editor

Royalties, Lippincott Williams and Wilkins

Robert Quencer 

Consulting Editor

None, N/A

Mark Mullins

Associate Editor

Non-remunerative position, AUR6

Meng Law

Associate Editor

Stockholder, Clinical Imaging

Michele Johnson

Associate Editor

Consultant, Boston Scientific, Inc.

Edward Escott

Associate Editor

Grant, Atherysys, Inc.; Royalties, Thieme Medical Publishers

Scott Faro

Associate Editor

None, N/A

Tina Young Poussaint

Associate Editor

None, N/A

Dheeraj Ghandi

Associate Editor

Grant, Arstasis, Axera Inc.; Consultant, Covidien, EV3

Contact Information:
If you have questions regarding this enduring material activity, please contact us at

Privacy Policy and Confidentiality Policy:
The ASNR does not share your personal information provided to this site with any third party, except where required by CME governing bodies for verification of CME activities. Your email address will only be used to contact you in relation to your activities on the website, except where you have given ASNR permission to contact you with additional information. ASNR adheres to the same policy for members as nonmembers, except that: ASNR member mailing address information may be shared with providers of accredited CME activities.

Copyright © American Society of Neuroradiology, 2011-2017