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Neuroimaging pp 1303-1326 | Cite as

Myelography

  • Raymond F. Carmody

Abstract

Computed tomography (CT) and magnetic resonance imaging (MRI) of the spine have drastically reduced the need for myelography. Although it was once the primary procedure for evaluating disorders affecting the spinal cord and nerve roots, today myelography plays only a minor role in neuroradiology. Being an invasive procedure it should not be the initial test performed in the workup of radiculopathies or myelopathies, since both CT and MRI have equal or superior accuracy.1–10 Instead, myelography is now used (1) to clarify equivocal or “soft” findings on CT or MRI, (2) when CT and MRI give conflicting results, (3) when these noninvasive procedures are negative in the face of compelling clinical evidence of disease, or (4) when metallic devices in the spine preclude diagnostic CT and MRI. This last indication is the main season myelograms are still performed at our institution. Moreover, some surgeons, having for years based their surgical decisions on myelographic information, are uncomfortable operating without a myelogram, whereas others simply want an additional confirmatory test before proceeding. Presumably, as clinicians become more familiar and comfortable with spinal CT and MRI, their insistence on myelography will disappear. Meanwhile, radiologists will have to be familiar with and adept at myelographic techniques and interpretation. This chapter is by no means an all-inclusive discussion of myelography or the many disease entities one may demonstrate by this procedure; rather, it is intended more as an introduction to fundamental principles. Most of the diseases discussed in this section on the abnormal myelogram are more thoroughly covered elsewhere in this textbook

Keywords

Disk Herniation Cervical Spondylosis Root Sheath Postdural Puncture Headache Thoracic Disk Herniation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Reference

  1. 1.
    Ketonen L, Gyldensted C. Lumbar disc disease evaluated by myelography and post myelography spinal computed tomography. Neuroradiology 1986; 28: 144 - 149.PubMedCrossRefGoogle Scholar
  2. 2.
    Masaryk TJ, Modic MT, Geisinger MA, et al. Cervical Myelopathy: A comparison of magnetic resonance and myelography. J Comput Assist Tomogr 1986; 10 (2): 184 - 194.PubMedCrossRefGoogle Scholar
  3. 3.
    Modic MT, Masaryk T, Boumphrey F, Goormastic M, Bell G. Lumbar herniated disk disease and canal stenosis: prospective evaluation by surface coil MR, CT, and myelography. AJNR 1986; 7: 709 - 717.Google Scholar
  4. 4.
    Modic MT, Masaryk TJ, Mulopulos GP, Bundschuh C, Han JS, Bohlman H. Cervical radiculopathy: prospective evaluation with surface coil MR imaging, CT with metrizamide, and metrizamide myelography. Neuroradiology 1986; 161: 753 - 759.Google Scholar
  5. 5.
    Ross JS, Perez-Reyes N, Masaryk TJ, Bohlman H, Modic MT. Thoracic disk herniation: MR imaging. Radiology 1987; 165: 511 - 515.PubMedGoogle Scholar
  6. 6.
    Williams MP, Cherryman GR. Thoracic disk herniation: MR imaging. Radiology 1988; 167: 874 - 875.PubMedGoogle Scholar
  7. 7.
    Schipper J, Kardaun J, Braakman R, van Dongen KJ, Blaauw G. Lumbar disk herniation: diagnosis with CT or myelography. Radiology 1987; 165: 227 - 231.PubMedGoogle Scholar
  8. 8.
    Karnaze MG, Gado MH, Sartor KJ, Hodges FJ. Comparison of MR and CT myelography in imaging the cervical and thoracic spine. AJR 1988; 150: 397 - 403.PubMedGoogle Scholar
  9. 9.
    Larsson EM, Holt S, Cronqvist S, Brandt L. Comparison of myelography, CT myelography and magnetic resonance imaging in cervical spondylosis and disk herniation. Acta Radiol 1989; 30: 233 - 239.PubMedCrossRefGoogle Scholar
  10. 10.
    Fagerlund MKJ, Thelander UE. Comparison of myelography and computed tomography in establishing lumbar disc herniation. Acta Radiol 1989; 30: 241 - 246.PubMedCrossRefGoogle Scholar
  11. 11.
    Bergeron RT, Rumbaugh CL, Fang H, Cravioto H. Experi- mental Pantopaque arachnoiditis in the monkey. Radiology 1971; 99: 95 - 101.PubMedGoogle Scholar
  12. 12.
    Kendall B. Iohexol in paediatric myelography. Neuroradiology 1986; 28: 65 - 68.PubMedCrossRefGoogle Scholar
  13. 13.
    Lille F, Bach-Gansmo T, Weber H. Lumbar myelography with Omnipaque (iohexol). Neuroradiology 1986; 28: 344 - 346.CrossRefGoogle Scholar
  14. 14.
    Sand T, Stovner LJ, Dale L, Salvesen R. Side effects after diagnostic lumbar puncture and lumbar iohexol myelography. Neuroradiology 1987; 29: 385 - 388.PubMedCrossRefGoogle Scholar
  15. 15.
    Maly P, Bach-Gansmo T, Elmqvist D. Risk of seizures after myelography: comparison of iohexol and metrizamide. AJNR 1988; 9: 879 - 883.PubMedGoogle Scholar
  16. 16.
    Nestvold K, Sortland O. Lumbar myelography with iohexol: adverse effects compared with spinal puncture. Acta Radiol 1988;29:637-640.PubMedGoogle Scholar
  17. 17.
    Sand T, Myhr G, Stovner LJ, Dale LG. Side effects after lumbar iohexol myelography: relation to radiological diagnosis, sex and age. Neuroradiology 1990; 31: 523 - 528.PubMedCrossRefGoogle Scholar
  18. 18.
    Skalpe IO, Nakstad P. Myelography with iohexol (Omnipaque); a clinical report with special reference to the adverse effects. Neuroradiology 1988; 30: 169 - 174.PubMedCrossRefGoogle Scholar
  19. 19.
    Drayer BP, Warner MA, Sudilovsky A, et al. Iopamidol vs metrizamide: a double blind study for cervical myelography. Neuroradiology 1982; 24: 77 - 84.PubMedCrossRefGoogle Scholar
  20. 20.
    Drayer BP, Vassallo C, Sudilovsky A, et al. A double-blind clinical trial of iopamidol versus metrizamide for lumbosacral myelography. J Neurosurg 1983; 58: 531 - 537.PubMedCrossRefGoogle Scholar
  21. 21.
    Valk J, Crezee FC, deSlegte GRM, Hazenberg GJ, Wolbers J, Bach-Gansmo T. Iohexol 300 mgI/ml versus iopamidol 300mgI/ml for cervical myelography double blind trial. Neuroradiology 1987; 29: 202 - 205.PubMedCrossRefGoogle Scholar
  22. 22.
    Hoe JWM, Ng AMN, Tan LKA. A comparison of iohexol and iopamidol for lumbar myelography. Clin Radiol 1986; 37: 505 - 507.PubMedCrossRefGoogle Scholar
  23. 23.
    Provinciali L, Signorino M, Giovagnoli AR, et al. Lumbar myelography with iopamidol: a methodological approach to the investigation of side effects. Neuroradiology 1988; 20: 528 - 533.CrossRefGoogle Scholar
  24. 24.
    Vezina JL, Fontaine S, Laperriere J. Outpatient myelography with fine-needle technique: an appraisal. AJNR 1989; 10: 615 - 617.PubMedGoogle Scholar
  25. 25.
    Sand T, Myhr G, Stovner LJ, Dale LG, Tangerud. Side effects after ambulatory lumbar iohexol myelography. Neuroradiology 1989; 31: 49 - 54.PubMedGoogle Scholar
  26. 26.
    Sand T. Which factors affect reported headache incidences after lumbar myelography? A statistical analysis of publications in the literature. Neuroradiology 1989; 31: 55 - 59.PubMedGoogle Scholar
  27. 27.
    Dittman M, Shaefer HG, Renkl F, Greve I. Spinal anesthesia with 29-gauge Quincke point needles and postdural puncture headaches in 2,378 patients. Act Anesthesiol Scand 1994; 38: 691 - 693.CrossRefGoogle Scholar
  28. 28.
    Peterman SB. Postmyelography headache rates with Whitacre vs. Quincke 22-gauge spinal needles. Radiology 1996; 200: 771 - 778.PubMedGoogle Scholar
  29. 29.
    Liebold RA, Yealy DM, Coppola M, Cantees KK. Postdural puncture headache: Characteristics, management, and prevention. Ann Emerg Med 1993; 22: 1863 - 1870.CrossRefGoogle Scholar
  30. 30.
    Simon JH, Ekholm S, Kido D, Utz R, Erickson J. High-dose iohexol myelography. Radiology 1987; 163: 455 - 458.PubMedGoogle Scholar
  31. 31.
    Crane R, Margolis MT. Use of sitting position to relieve myelographic obstruction. AJNR 1986; 7: 502 - 503.PubMedGoogle Scholar
  32. 32.
    Kapila A, Chakeres DW. Flexed sitting maneuver for complete lumbar myelography in patients with severe spinal stenosis and apparent block. Radiology 1986; 160: 265 - 267.PubMedGoogle Scholar
  33. 33.
    Choudhri AH, Rowlands PC, Barber CJ, Johnson J, Stevens JM. Outpatient myelography: an acceptable and cost-effective technique. Br J Radiol 1989; 62: 253 - 255.PubMedCrossRefGoogle Scholar
  34. 34.
    Wang H, Binet EF, Gabrielsen TO, Rosenbaum AE. Lumbar myelography with iohexol in outpatients: prospective multicenter evaluation of safety. Radiology 1989; 173; 239 - 242.PubMedGoogle Scholar
  35. 35.
    Fagerlund MKJ. Computed tomography in low back pain before and after myelography: a qualitative comparison. Acta Radiologica 1988; 29: 353 - 356.PubMedGoogle Scholar
  36. 36.
    Kaplan JO, Quencer RM, Stokes NA, Donovan MJ. Improved technique for cervical metrizamide myelography. Radiology 1980; 135: 519 - 520.PubMedGoogle Scholar
  37. 37.
    Robertson HJ, Smith RD. Cervical myelography: survey of modes of practice and major complications. Radiology 1990; 174: 79 - 83.PubMedGoogle Scholar
  38. 38.
    Skalpe IO. Cervical myelography. Radiology 1990; 177: 590 - 591.PubMedGoogle Scholar
  39. 39.
    Heinz RE. Techniques in imaging of the spine, Part 3: Myelography. In: The Clinical Neurosciences. vol. 4, Rosenberg RN, ed. NY: Churchill Livingston; 1984, pp. 795 - 817.Google Scholar
  40. 40.
    Burt TB, Seeger JF, Carmody RF, Yang PJ. Dural infolding during C1-2 myelography. Radiology 1986; 158: 546 - 547.PubMedGoogle Scholar
  41. 41.
    Raininko R, Sonninen P. Dorsal CSF space at CI-II: Technique of cervical myelography. Neuroradiology 1987; 29: 73 - 75.PubMedCrossRefGoogle Scholar
  42. 42.
    Johansen JG, Orrison WW, Amundsen P. Lateral C-2 puncture for cervical myelography, Part I: Report of a complication. Radiology 1983; 146: 391 - 393.Google Scholar
  43. 43.
    Muller-Vahl, Vogelsang H. Spinal cord injury caused by a lateral Cl-2 puncture for cervical myelography. Eur J Radiol 1986; 6: 160 - 162.PubMedGoogle Scholar
  44. 44.
    Rogers LA. Acute subdural hematoma and death following lateral cervical spinal puncture: Case report. J Neurosurg 1983; 58: 284 - 286.PubMedCrossRefGoogle Scholar
  45. 45.
    Abla AA, Rothfus WE, Maroon JC, Deeb ZL. Delayed spinal subarachnoid hematoma: a rare complication of Cl-C2 cervical myelography. AJNR 1986; 7: 526 - 528.PubMedGoogle Scholar
  46. 46.
    Valk J. Lateral cervical Cl-C2 puncture in cervical myelography. Eur Neurol 1982; 21: 175 - 180.PubMedCrossRefGoogle Scholar
  47. 47.
    Peterman SB. Postmyelography headache: A review. Radiology 1996; 200: 765 - 770.Google Scholar
  48. 48.
    Peterson HO, Kieffer SA. Introduction to Neuroradiology. Hagerstown MD: Harper & Row; 1972, p. 202.Google Scholar
  49. 49.
    Haughton VM. Disc disease, degenerative spine disease and tight spinal canal. In: The Clinical Neurosciences. vol. 4, Rosenberg RN, ed. NY: Churchill Livingston; 1984, pp. 865 - 885.Google Scholar
  50. 50.
    Fox AJ, Lin JP, Pinto RS, Kricheff II. Myelographic cervical nerve root deformities. Radiology 1975; 116: 355 - 361.PubMedGoogle Scholar
  51. 51.
    Penning L, Wilmink JT, van Woerden HH, Knol E. CT myelographic findings in degenerative disorders of the cervical spine: clinical significance. AJR 1986; 146: 793 - 801.PubMedGoogle Scholar
  52. 52.
    Braun IF, Hoffman JC, Davis PC, Landman JA, Tindall GT. Contrast enhancement in CT differentiatioin between recurrent disk herniation and post operative scar: prospective study. AJNR 1985; 6: 607 - 612.Google Scholar
  53. 53.
    Yang PJ, Seeger JF, Dzioba RB, et al. High-dose IV contrast in CT scanning of the postoperative lumbar spine. AJNR 1985; 7: 703 - 707.Google Scholar
  54. 54.
    Hueftle MG, Modic MT, Ross JS, et al. Lumbar spine: postoperative MR imaging with Gd-DTPA. Radiology 1988; 167: 817 - 824.PubMedGoogle Scholar
  55. 55.
    Ross JS, Delamarter R, Hueftle MG, et al. GadoliniumDTPA-enhanced MR imaging of the postoperative lumbar spine: time course and mechanism of enhancement. AJNR 1989; 10: 37 - 46.Google Scholar
  56. 56.
    Sotiropoulos S, Chafetz NI, Lang P, et al. Differentiation between postoperative scar and recurrent disk herniation: prospective comparison of MR, CT, and contrast-enhanced CT. AJNR 1989; 10: 639 - 643.PubMedGoogle Scholar
  57. 57.
    Ross JS, Masaryk TJ, Schrader M, Gentili A, Bohlman H, Modic MT. MR imaging of the postoperative lumbar spine: assessment with gadopentetate dimeglumine. AJNR 1990; 11: 771 - 776.PubMedGoogle Scholar
  58. 58.
    Carmody RF, Yang PJ, Seeley GW, Seeger JF, Unger EC, Johnson JE. Spinal cord compression due to metastatic disease: diagnosis with MR imaging versus myelography. Radiology 1989; 173: 225 - 229.PubMedGoogle Scholar
  59. 59.
    Shapiro R. Myelography 4th ed., Chicago: Year Book Medical Publishers, Inc, 1984, p. 359.Google Scholar
  60. 60.
    Shapiro R, op cit, p. 187.Google Scholar
  61. 61.
    Sackett JF, Strother CM. New Techniques in Myelography.Hagerstown, Md: Harper & Row; 1979, p. 81.Google Scholar

Copyright information

© Springer Science+Business Media New York 2000

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  • Raymond F. Carmody

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