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Ninety brachial plexus lesions have been examined by myelography and the results classified into six types. These were compared against the level of lesion found at exploration of the brachial plexus with electrophysiological investigations carried out during the operation. The results show that myelography can be a reliable and useful pre-exploratory measure to assess the level of the lesion of each injured root.
Tibial nerve and S1 dermatome somatosensory evoked potentials (SSEPs) were recorded before and after iohexol lumbar myelography in order to evaluate possible neurotoxic effects of this contrast medium. No significant change in SSEP latencies nor amplitudes was noted after iohexol myelography, supporting the low neurotoxic profile of this contrast agent. Results were compared to those of a control group of patients before and after lumbar puncture (LP), without injection of contrast agent. In this group also no significant change in SSEP components was found, indicating that a preceding LP does not affect this electrophysiological examination.
Two series of newly diagnosed patients with medulloblastoma are compared in terms of survival, relapse-free survival, and sites of relapse. Patients in series I were all diagnosed and treated prior to 1974 and did not have the benefit of myelography and CSF cytology for staging. All patients treated after 1974 had myelography and most had CSF cytology studies prior to radiotherapy. In addition, patients in the latter series were all followed with CT scanning. Improved survival and relapse-free survival rates were seen in the series II patients. Approximately 30% of the staged patients have had abnormal myelograms. It is suggested that involved portions of the cord be treated with higher doses than the usual prophylactic doses. The better results seen in the series II patients are probably due in part to a combination of adequate staging with radiation doses to the neuraxis based on the staging, close followup with CT scanning, and aggressive re-treatment of relapses.
A case of cranial subdural hematoma after lumbar myelography is reported. The literature of this unusual complication of lumbar myelography is reviewed and the possible mechanism is discussed briefly.
One hundred patients with degenerative disease of the lumbar spine on whom both magnetic resonance (MR) and computed tomography (CT)-myelography were performed were reviewed. In one-third of the cases, the CT-myelogram provided additional useful information. This included definition of the extent of large disc herniations, demonstration of focal neural compression by small herniations, and clarifying abnormalities of the facets, including synovial cysts. These results should help to refine the indications for CT-myelography, which continues to be requested extensively.
Transient hearing impairment is a known sequel after various procedures that result in loss of cerebrospinal fluid, such as lumbar puncture, spinal anesthesia and myelography. But persistent or recurrent hearing loss after dural puncture is a rare entity. We present a case with recurrent low-frequency sensorineural hearing loss after myelography. The patient was treated successfully by means of an epidural blood patch, although the conservative treatment was ineffective.
A case of a cerebrospinal fluid fistula developing following a lumbar puncture done for myelography is described. Radiographic documentation was obtained by a sinogram using an oily contrast medium. The exact aetiology of the fistula was undetermined, however, the large calibre of the spinal needle used for lumbar puncture as well as the patient's decubitus ulcer in the early post-myelography state may have had a role to play. The presence of a low grade infection also remains a possibility as the needle used was of an autoclaved, reusable type.
We report on paravertebral extravasation of water soluble contrast medium seen during lumbar myelography and/or subsequent post myelogram CT in 10 patients. This is an uncommon feature of lumbar myelography occurring in less than 1% of cases in our experience and which has not been previously documented.
OBJECTIVE: To determine which components of cervical spondylosis are most frequently present in patients with myelopathy. DESIGN: We reviewed the findings in 93 patients who underwent surgical decompression for cervical spondylotic myelopathy between January 1986 and December 1989 at Mayo Clinic Rochester. MATERIAL AND METHODS: All 93 patients (72 men and 21 women) underwent computed tomographic (CT) myelography. In addition, magnetic resonance imaging scans were available in 25 patients, and plain CT scans were obtained in 2. RESULTS: A review of CT myelograms revealed that all neurocompressive intraspinal spondylotic changes were reflected in the shape of the spinal cord. Among the 93 patients with myelopathy, the configuration of the spinal cord could be categorized into primarily three dominant types: A (severe encroachment that compressed the cord into the shape of a banana; N = 40), B (moderate encroachment that produced less prominent compression; N = 23), and C (moderate bilateral uncovertebral spurs; N = 12). As a comparison group, 30 patients with similar spinal cord deformities but without progressive myelopathy were analyzed. Correlation of the two groups showed that myelopathy was present in up to 98% of patients with type A spinal cord, in 75% with type B, and in 71% with type C. The findings on magnetic resonance imaging were similar to those on CT myelography, but the bony spondylotic components were less readily seen. CONCLUSION: The precise pathophysiologic mechanism of myelopathy in spondylosis remains an enigma. Although the bulk of the data on our patients supports direct compression, we believe that the cause is multifactorial.
BACKGROUND: Precise determination of the spinal level of a cerebrospinal fluid leak is important in the diagnosis and treatment of spontaneous intracranial hypotension. The authors report two cases of SIH in which a cerebrospinal fluid leak was demonstrated by three-dimensional computed tomographic (3D-CT) myelography. CASE DESCRIPTION: By overlaying 3D-CT images of contrast-enhanced CSF and the spine, the point of leakage was clearly depicted in the three-dimensional spinal structure, which assisted targeted epidural blood patch under the guidance of fluoroscopy. Although associated chronic subdural hematoma had to be treated by burr hole drainage, the patients' postural headaches subsided after treatment. CONCLUSION: Clear CSF images in relation to vertebral bones are obtainable with 3D-CT myelography, rendering this modality very useful for the diagnosis and treatment of spontaneous intracranial hypotension.
The role of myelography combined with myelo-CT in the evaluation of degenerative disease of the spine is judged differently. If MRI cannot be performed at a technically 'state of the art' standard, myelography combined with CT is the most informative link in the diagnostic chain, providing additional information to plain CT or technically inadequate MRI examinations, contributing to the final diagnosis and substantially directing the therapeutic strategy. For the preoperative evaluation of spinal stenoses, any compression of the nerve roots or the spinal cord by osseous spurs or soft tissue structures is best assessed after intrathecal administration of contrast medium.
In this report two unusual and serious neurological complications of dimeglumine iocarmate (Dimer X) myelography is presented. One patient became paraplegic six hours after myelography, and the other was mute for 24 hours after having generalised convulsions. The reasons are discussed.
Magnetic resonance imaging provides a good-quality image over the entire length of the spine and can assess the morphology of the discs and cord. It is the imaging modality of choice in the investigation of spinal diseases. Magnetic resonance myelography (MRM) is non-invasive, has comparable sensitivity to conventional myelography in visualizing lumbar nerve roots and allows overall assessment of the spinal canal even in the presence of cerebrospinal fluid block. Seventy-two patients with pre-surgical diagnosis of disc herniation were prospectively investigated prior to surgery to determine the value of MRM in the diagnosis of disc herniation and spinal stenosis. The difference between the sensitivity and accuracy of MRI (89.0-95.6%, 89.1-95.7%) and MRM (82.4-89.0%, 82.6-89.1%) was not significant for both observers. There was no significant improvement with the addition of MRM to MRI (91.2-97.8%, 91.3-97.8%). Although MRM did not significantly improve the diagnostic accuracy of MRI, it allowed a better overall view of the dural sac and root sleeves, therefore making it easier to diagnose spinal stenosis and disc herniation in a minority of cases.
The reported incidence of clinically significant arachnoiditis following oil-based contrast media myelography is approximately 1%. The incidence of arachnoiditis in the dorsal spine is even more rare. Acquired arachnoid cyst formation can occur with arachnoiditis of various aetiologies. A case is presented of a patient with chronic backache, radiculopathy, weakness and muscle wasting, who had undergone myelography with oil-based contrast media about 28 years ago. There was no history of spinal surgery, spinal canal stenosis, disc disease or trauma, all of which are known to increase the risk of arachnoiditis. Magnetic resonance imaging features are presented in this case of arachnoiditis with arachnoid cyst formation, and cord tethering.
In the exact diagnosis of space-occupying processes of the lumbosacral spine myelography with water-soluble contrast media is unsurpassed. Neurotoxicity of the water-soluble contrast media is known and feared in many centres. However, after 2500 exclusively in-patient lumbosacral myelographies and after a prospective study of 100 patients we were able to demonstrate that this investigation is only slightly dangerous.
An emergency myelography was performed on 51 patients with acute cauda equina syndrome. Altogether 23 total obstructions for various causes were found; as well as 13 disc herniations, 2 spinal stenoses and 13 patients with minimal findings in water-soluble myelography. A scheme was developed to analyse the cause of the obstruction and the level of the obstruction in disc herniation cases. The scheme seems to function fairly well, although we have had three errors in the diagnoses of 23 obstructions.
Two patients with severe kyphoscoliosis developed marked spinal irritation following myelography with the new non-ionising contrast medium Amipaque. The authors raise the possibility that the spinal deformity may result in reduced flow of cerebro-spinal fluid; this may prolong the contact of the contrast medium with the (previously damaged?) spinal cord. Patients with this type of spinal deformity require particularly stringent indications for the performance of myelography, even when using Amipaque.
The potential of digital luminescence radiography in replacing conventional myelography was analyzed using ROC methodology. 95 conventional (CR), digital (DR) and edge enhanced digital (EDR) myelograms (49 disk herniations, 46 normal) were read independently by 5 radiologists; and a ROC analysis was performed. Higher confidence levels were used in making both correct and incorrect diagnoses with DR and EDR than with CR. However, no statistically significant differences between AUC (area under the curve) values obtained with the different techniques, were noted. The separate analysis of cervical and lumbar myelograms showed no significant differences between the different techniques. With DR and EDR, the sensitivity of 4 of 5 readers was somewhat higher in the lumbar but lower in the cervical region than with CR. Replacement of conventional by digital luminescence myelography seems possible; however, some decrease of sensitivity in the cervical region must be accepted.