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PubMed1977

Adhesive arachnoiditis after lumbar myelography.

Of 1500 myelographies, 99 patients had subsequent myelographies from which the prevalence of adhesive arachnoiditis caused by the initial investigation could be calculated. Three different water-soluble contrast agents had been used in the initial study: Kontrast U (800 patients), Dimer-X (400 patients), and Conray (300 patients) and the subsets of patients restudied represented 6%, 8% and 8% respectively of the whole series. After the first myelography 68 patients had no operation, 31 patients had hemilaminectomy. Conray produced arachnoid changes in 71% of the nonoperated patients. This differed significantly from the 43% caused by Kontrast U, and the 27% evoked by Dimer-X. The same trend was evident in the operated subset. The severity of the arachnoid changes was greater after Conray. Analysis of the iodine content of the different contrast media and comparison with similar series suggested that hyperosmolarity of the agent was responsible for the changes.

Arachnoiditis↗
PubMed1990

[A comparison of myodil and omnipaque as contrast media in myelography].

The myelographic results of 30 cases in each group using myodil and omnipaque respectively were compared. As far as intraspinal extramedullary lesions were concerned, the diagnostic value of either contrast medium was almost the same. If CT scan was used along with omnipaque myelography, the fine structural changes could better be observed. As to the intramedullary lesions of the spinal cord, both contrast media seemed to be of less diagnostic value even though CT scan was used together. This was especially true in cases of demyelinating lesions. But it seemed to the authors that the number of the cases studied was too small to draw a definite conclusion. The side effects and toxicity of omnipaque as a contrast medium in myelography were less than those of myodil. However, myodil myelography might be useful and not abandoned in those areas where local economic conditions and facilities were less favorable.

Adolescent↗
PubMed1990

Isthmic lumbar spondylolisthesis with sciatica. MR imaging vs myelography.

Seventeen patients with sciatica and isthmic lumbar spondylolisthesis were studied with magnetic resonance (MR) imaging. In 13, myelography was also performed: 5 had dural sac deformation and root sleeve shortening, 2 had deformation with unilateral root sleeve shortening, one had bilateral root sleeve shortening only, and one had sac deformation only. In 4, myelography was normal. On sagittal MR examinations the neural foramen had an altered shape bilaterally with the long axis horizontal in all cases. In addition to altered shape the following was found in the 33 foramina evaluated. I: normal nerve (n = 8); II: compressed nerve (n = 16); III: disappearance of fat, nerve not possible to identify (n = 9). In patients with unilateral sciatica, the degree of foraminal stenosis correlated well with the side of symptoms. Coronal views showed the course of the nerve and pedicular kinking. Eight patients underwent decompressive surgery which revealed nerve compression by hypertrophic fibrous tissue and pedicular kinking, which correlated well with the findings on MR. Since the site of nerve compression often was peripheral to the root sleeves, myelography did not give complete information.

Adult↗
PubMed1989

Iotrolan, a nonionic dimeric contrast medium in myelography.

As part of a clinical Phase III study of the nonionic, dimeric contrast medium iotrolan, differences in opacification, tolerance, and effects on the electroencephalogram after myelography were examined in a double-blind comparison with iohexol. Two groups of 25 patients each received either 10 ml iotrolan 240 mg I/ml or 10 ml iohexol 240 mg I/ml for lumbar myelography, and two groups of 50 patients each received either 10 ml iotrolan 300 mg I/ml or 10 ml iohexol 300 mg I/ml for lumbar, thoracic or cervical myelography. The overall assessment of the opacification in the subarachnoid space, which was moderate in only one case of each group and otherwise good, showed no differences between the preparations. The tolerance of both concentrations of iotrolan proved to be significantly better than those of iohexol: at a significance level in the chi-square test of p less than 0.001 in a simple size of 25 patients per preparation with 240 mg I/ml and at a significance level of p +/- 0.05 in a sample size of 50 patients per preparation with 300 mg I/ml.

Adult↗
PubMed1989

[Risk and value of conventional myelography with reference to the radiation burden of the patient].

To estimate the effective equivalent dosage with reference to the area under examination and the foils employed, fifty patients underwent conventional diagnostic myelography, after which, by means of thermoluminescence surface dosimetry, the mean organ dosage was ascertained from the radiation field size, using a computer program ORDOS. Effective equivalent dosage can be used to determine the inherent risk of radiation injury involved. The risk-benefit ratios obtained would suggest that conventional myelography, prospectively in the form of digital myelography, and spinal computer tomography are not opposing but complementary approaches to spinal diagnosis. Spinal magnetic resonance (MR) merits discussion not from the aspect of exposure to radiation but that of availability.

Adult↗
PubMed1989

[Adverse reactions and intracranial contrast medium after myelography].

Correlation between adverse reactions and intracranial contrast media after myelography was studied. Myelography was carried out for 12 cases with metrizamide and 14 with iotrolan. In all patients, cranial CT scans were performed 18 approximately 22 hours after myelography. CT attenuation value of subarachnoid cistern was higher than the gray matter in 12 cases and lower in 14 cases. Six cases suffered from adverse reactions, but only 1 case belongs to the higher group. No correlation between adverse reactions and residual amount of contrast medium on CT was recognized.

Adult↗
PubMed1989

CSF TRAP: a procedure to improve laboratory testing with myelography.

CSF TRAP (Transport and Rapid Accessioning for Additional Procedures) is a procedure that provides storage of and rapid access to cerebrospinal fluid (CSF) specimens and allows clinicians to review initial findings before ordering low-yield CSF studies. The cost-effectiveness of routinely using the CSF TRAP procedure with myelography is examined in a study group of 819 patients, 74% with disc diseases, spinal stenosis, spondylolisthesis, or pain syndromes, 10% with cancer, and 16% with neuropathies and miscellaneous conditions. Routine studies on CSF obtained during myelography provided little additional clinical information, except for patients with cancer (of 80 patients with cancer, the results of cytological examination of the CSF were positive in 12) and patients with multiple sclerosis, for whom oligoclonal band and IgG analysis provided supportive diagnostic data. The utilization of the CSF TRAP procedure with elimination of unnecessary culture and cytological studies on patients with disc diseases, spinal stenosis, spondylolisthesis, and pain syndromes, reduces myelographic CSF procedures by 20%, for a savings exceeding $14,000. The CSF TRAP procedure allows for a more cost-efficient analysis of CSF obtained using myelography, while providing fluid for analysis in patients with unexpected findings.

Adult↗
PubMed1986

Magnetic resonance imaging compared with computed tomography and myelography in the diagnosis of spinal masses.

Magnetic resonance imaging (MRI) is superior to computed tomography (CT) and myelography in the demonstration and delineation of the extent of syringomyelia. In the detection of intramedullary tumors MRI is more sensitive than CT and myelography. MRI provides additional information on the sagittal and frontal planes regarding the extent of tumors. In the diagnosis of disc prolapse MRI seems to be as accurate as CT or myelography. Additional information is available with MRI in the diagnosis of degenerated disc tissue. Spinal stenosis is easily recognizable. CT was superior in the differentiation of bony and disc protrusion. The results show that MR has opened up new possibilities in the diagnosis of spinal diseases and will lead to a reorientation of the diagnostic approach.

Diagnosis, Differential↗
PubMed1977

Technique of lumbar myelography with metrizamide.

It is not possible to change from oily to aqueous contrast media for myelography without modifying the entire technique. The advantages of myelography with metrizamide (Amipaque) are so great in terms of improved diagnostic accuracy, no withdrawal of contrast medium and reduced incidence of arachnoiditis that it is firmly believed that this technique will soon replace oily myelography as standard practice, at least for the lumbar and thoracic regions.

Humans↗
PubMed1987

[Arachnoiditis ossificans after repeated myelographies and spinal operations--a case report and review of the literature].

A 58-year-old female was admitted because of lumbago and dysesthesia on the lateral aspect of the left leg. She had myelographies and spinal operations 4 years ago. Metrizamide myelogram on admission revealed the findings of adhesive arachnoiditis. During operation, four plaques involving the cauda equina were found, removed and histologically proved to be osseous tissue. In reviewing the previously published cases of arachnoiditis ossificans, it is divided into two forms. One is incidentally found in the arachnoid membrane at the time of an autopsy or spinal operation. The other is a progressive form causing impairment of the spinal cord and cauda equina. Compared with the former, the latter is extremely rare. At present, there appears to be a general agreement about the pathological process to ossification in the latter. The ossified plaque has its origin in meningothelial cell clumps located at the junction of the arachnoid sheet and the trabecula. The ossification occurs secondarily as a result of degenerative change in these clumps after myelography, spinal operation, subarachnoid hemorrhage, spinal trauma and spinal anesthesia. In our case, it is presumed that repeated spinal operations or myelographies played a role as a trigger toward ossification.

Arachnoiditis↗
PubMed1988

Risk of seizures after myelography: comparison of iohexol and metrizamide.

A parallel, double-blind, randomized study comparing iohexol and metrizamide--both 180 mg l/ml--in lumbar myelography was carried out in 60 consecutive patients. Eight to 15 ml of contrast medium were administered with the upper level at the middle thoracic column. A detailed neurologic examination was performed before and 24 hr after myelography. EEG recordings--evaluated visually and with fast Fourier transformation analysis--and somatosensory evoked responses were registered before, 6 hr after, and 24 hr after myelography. All patients were observed for adverse reactions for 24-48 hr. Iohexol did not produce any epileptiform activity but epileptiform activity was detected in five patients receiving metrizamide. Iohexol produced significantly less frequent and less severe EEG changes than did metrizamide both at visual evaluation (p less than .0025) and at fast Fourier transformation analysis (p less than .04). No significant changes occurred in the early components of the somatosensory evoked potentials after either contrast medium. Iohexol caused significantly (p less than .002) less frequent and less severe adverse reactions than did metrizamide. The neurologic examination revealed no changes of clinical importance with either contrast agent.

Double-Blind Method↗
PubMed1988

[Myelography in obstetrical paralysis of the brachial plexus].

The use of myelography in obstetric palsies of brachial plexus is aimed at diagnosing root avulsion. This kind of lesion appears as the disappearance of the slightly transparent nerve roots which might be combined either with pseudomeningocele or with deformation of radicular pouch. In our study we considered 69 operated patients who had previously undergone myelography. In 74.2% of cases myelographic findings were confirmed at surgery. False positives and false negatives were 9.7% and 3.2%, respectively. Incorrect diagnoses were made in 12.9% of cases, because of misread lesions and incorrect evaluation of their location, usually at the cervico-dorsal junction. No side-effects were observed. Myelography appears thus to be extremely useful for both the preoperative evaluation and the choice of surgery in newborn children with obstetric palsy of the brachial plexus.

Brachial Plexus↗
PubMedDate not supplied

Lumbar myelography with iohexol. Adverse effects compared with spinal puncture.

Since 1983 iohexol has been routinely used for myelography in our hospital and 1,650 myelographies have been performed. The first 331 patients with lumbar myelography were included in a follow-up study. Headache was observed in 26 per cent, nausea in 12 per cent and vertigo in 6 per cent of the patients, a frequency very similar to that observed in an earlier study of side effects following spinal puncture. Severe reactions were not seen. Three patients had radicular symptoms and 3 patients had minor mental symptoms possibly caused by the contrast medium. It is concluded that most side effects are related to the spinal puncture and that iohexol probably can be used with safety in out-patients.

Adolescent↗
PubMed1987

Influence of anesthetic regimen on the frequency of seizures after cervical myelography in the dog.

We examined the influence of various anesthetic drug combinations on the frequency of seizures in dogs after cervical myelography with metrizamide. Over a 12-month period, 78 dogs admitted to the teaching hospital for cervical myelography were assigned randomly to 1 of 6 anesthetic protocols. Myelography was performed, and the dogs were observed for signs of seizure activity after recovery from anesthesia. The person making the decision as to whether or not a dog had had a seizure was unaware of the anesthetic protocol that had been used. Preanesthetic treatment with pentobarbital (5.0 mg/kg) and maintenance of anesthesia with methoxyflurane significantly reduced the frequency of seizures (P less than 0.05). No reduction in seizure frequency was seen with any anesthetic protocol using halothane as the maintenance agent.

Anesthesia, General↗
PubMed1987

Comparison of the radiation doses in lumbar CT and myelography.

The radiation doses of the vertebral bodies and ovaries in lumbar CT and myelography were compared using a phantom. The CT examinations were performed with two different scanners using four different programs. At CT the radiation maximum doses of the vertebral bodies were higher than at myelography but the ovarian doses were lower. The radiation exposure does not prevent the use of CT instead of myelography, but the area of examination and the number of pictures should be limited to the minimum based on the clinical enquiry.

Female↗
PubMedDate not supplied

Myelography with iohexol (Omnipaque): review of 300 cases.

The side effects of iohexol were evaluated in the 300 patients who had nonemergency myelography over a 9 month period. No patients studied with myelography were excluded from the iohexol trial. Age range was 14-86 years. Introduction was by lumbar puncture in 206 patients and by lateral C1-C2 injection in 94. Side effects, including discomfort, were denied by 81.3% of the patients. The other 18.7% had adverse reactions, the most common being headache, reported by 11% of the total population studied. Image quality was judged unsatisfactory in 8.1% of cervical myelograms and in 2.6% of lumbar myelograms. With lumbar injection, cervical myelograms were judged to be inadequate in 13.5%; with cervical injection, lumbar myelograms were inadequate in 25%. Iohexol caused significantly fewer side effects in the 300 patients than would have been expected with metrizamide. The low cost and ease of use are additional factors that favor iohexol as the contrast agent of choice for myelography.

Adolescent↗
PubMedDate not supplied

C1-C2 myelography with iohexol and metrizamide: comparative study.

Comparison of metrizamide and iohexol contrast media for myelography performed via lateral C1-C2 puncture in a total of 64 patients demonstrated superiority of iohexol with respect to the incidence of postprocedure adverse reactions. There was no significant difference between the two media in quality of radiographic demonstration in the cervical region. Patients in whom posterior fossa positive-contrast radiographic examinations were performed at the same time as myelography, using either water-soluble agent, did not demonstrate any increased incidence of side effects over those having myelography alone.

Adult↗
PubMed1985

Role of computed tomography and myelography in the diagnosis of central spinal stenosis.

In order to evaluate radiographic methods for diagnosing central lumbar stenosis, we reviewed the computed tomography scans and myelograms of twenty-four patients who underwent surgical decompression for central lumbar stenosis. In the diagnosis of central lumbar stenosis, the measurement of the anterior-posterior diameter of the osseous canal by computed tomography was less reliable than the measurement of the dural sac by myelography. The dimensions of the canal derived from computed tomography provided a correct diagnosis in 20 per cent of the patients, while myelography was accurate 83 per cent of the time. The effectiveness of computed tomography was improved when the cross-sectional area of the dural sac was measured. We suggest that a narrow dural sac, demonstrated by myelography or by computed tomography, reliably indicates central spinal stenosis.

Adult↗