The present study highlights a three-dimensional orientation of subaxial cervical pedicle anatomy, while emphasizing the risks involved in the view of comparatively smaller values of pedicle dimensions of subaxial cervical vertebrae. This knowledge about typical cervical vertebrae, its pedicle and their adjacent neurovascular structures may enhance the safety of transpedicular screw insertion.

PURPOSE: To evaluate the safety and efficacy of a single instillation in a combination of povidone iodine with contrast agent under fluoroscopy guidance for the treatment of chyluria. MATERIALS AND METHODS: From December 1999 to July 2006 a total of 40 patients with chyluria were treated by renal pelvic instillation therapy (RPIS). The sclerosing solution was prepared using povidone iodine with contrast agent diluted with sterile water in a ratio of 1:1:3. It was instilled on the side having chylous efflux using a bulb tip ureteric catheter. Unilateral instillation was done in 26 cases, 10 on the right side and 16 on left. Fourteen patients had bilateral chylous efflux and RPIS was performed on both sides in the same session. Fluoroscopy was used to evaluate the complete filling of the pelvic calyceal system. The sclerosing solution was kept in the system for 5 minutes and the ureteric catheter was then withdrawn. RESULTS: Immediate clearance was observed in 39 patients. Recurrence occurred in five patients. They were treated again using the same procedure with satisfactory results. The longest follow-up was five years and the shortest five months. CONCLUSION: RPIS of chyluria using a single instillation a combination of povidone iodine with contrast agent is safe and effective. Use of fluoroscopy helps to determine the exact amount of sclerosing solution required to completely fill the system and therefore overfilling is avoided. Moreover, the complications, which arise due to pyelointerstitial backflow, are prevented

This technique helps to determine the correct site of skin puncture in the fluoroscopy-guided triangulation technique. It leads to a tract that is of optimum length, proper direction, and is in alignment with the infundibulum.

Absent twinkling is associated with significant pain, a recent colic episode and difficult guidewire passage across the calculus. These findings suggest that absent twinkling implies significant obstruction, while its presence indicates no significant obstruction.

Those cases of prenatally detected ureteropelvic junction type of hydronephrosis in which the anteroposterior pelvic diameter is smaller in the prone position than in the supine position showed improvement in hydronephrosis, while those with no change in anteroposterior pelvic diameter had worsening of hydronephrosis and needed surgical intervention.