Epidural venography for the diagnosis of lumbar intervertebral disc herniation

Abstract

There have been many reports on the application of epidural venography in patients with lumbar intervertebral disc herniations. Epidural venography has been applied to patients with low back pain for screening purposes or employed when myelographic findings were equivocal.During the period of 1972 to 1979, the author venographically investigated 57 cases with lumbar intervertebral disc herniations in which myelography was also carried out. It was found that 21 out of 57 cases (37%) showed caudal flow defects or cranial flow defects.In the case of flow defects, epidural venography does not permit to determine the precise level of involvement in the intervertebral space, unless the caudal or cranial anterior internal venous plexus is contrasted through its presacral vein. Catheterization of the presacral vein is not always easy. However, the conventional catheter was remodelled according, to the anatomical investigations of the presacral veins in 28 cadavers (56 limbs), in which the branches of the presacral veins were classified into five types. As a result, catheterization of the presacral vein and the ascending, lumbar vein was carried out without much difficulty.From 1979 to 1982, venography was applied to an additional 30 cases with lumbar intervertebral disc harniations admitted into the hospital for operations. At surgery, it was confirmed that herniated discs occurred exactly at the level, as indicated by the venography. In 6 cases showing caudal flow defects, caudal epidural venous plexus was contrasted by its catheterization of the presacral veins. In 2 cases showing cranial flow defects, the cranial venous plexus was contrasted by shifting the height of catheter tip toward the ascending lumbar veins on the left side.In 29 out of 30 cases, venographic findings agreed with operative findings.