Cervical Diskography Performed with a “Prong Deflector” for Improved Access to the Cervical Disk Spaces

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.

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).

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.