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Objective:
Lateral C1-C2 puncture is a rare procedure performed by neuroradiologists for various purposes, including CSF collection and contrast injection, when lumbar puncture is not available or contraindicated. Due to the infrequency of this procedure, there are limited opportunities to learn and practice the technique. We aimed to develop and assess the efficacy of a low-cost, reusable cervical spine phantom for use in fluoroscopically guided lateral C1-C2 puncture training.

Materials and Methods:
Model Construction: The phantom was constructed using a modified PVC cervical spine model, an outer latex tubing with a 12.7mm inner diameter representing the spinal canal, an inner latex modeling balloon with 5mm outer diameter representing the spinal cord, and alginate encompassing the model to replicate soft tissue. The total cost of materials for one model was approximately $65. The outer tube was filled with water and the inner balloon filled with dyed water so the spinal tap would reveal dyed water if the “spinal cord” was punctured. A valve was placed on one end of the outer tubing and a hemostat was used to secure the other end to maintain pressure and seal the canal. This enabled refilling of the canal and replacing of the latex balloon if the balloon was punctured in a previous attempt. Assessment of Training Efficacy: Workshop participants were provided with a pre- and post-survey assessing for comfort level in performing a puncture, confidence in having a successful puncture, and perception of current knowledge of the steps in a puncture. Training sessions were led by neuroradiology faculty at a single institution using the phantom model under fluoroscopic guidance. Survey questions were assessed on a 5-point Likert scale.

Results:
The sample size of the training group was 21 and consisted of radiology assistant students, medical students, residents, fellows, and attending physicians. Comfort level was improved by 2.00 points (standard deviation [SD]: 1.00, p-value <0.0001), confidence by 1.52 points (SD: 0.87, p-value <0.0001), and perception of current knowledge by 2.19 points (SD: 0.93, p-value <0.0001). 81% of participants found the model to be “very helpful” (5/5 on Likert scale), and all participants were “very likely” to recommend others to sign up for this workshop.

Conclusion:
This cervical phantom model is a low cost, replicable, and demonstrates clinical training utility to better prepare residents for lateral C1-C2 puncture. Lateral C1-C2 punctures are rare procedures, so the use of a phantom model prior to patient encounters will be invaluable to resident education and training.