Use Of Myelography Research Articles

Clinical-imaging aspects of the spinal arachnoid diverticulum in dog

Spinal arachnoid diverticulum is a focal, dilatative lesion of the arachnoid membrane, filled with cerebrospinal fluid and which can cause spinal cord compression of varying degrees. It can present as a primary or secondary, single or multiple lesion. Commonly, it affects the cervical segment in large dogs and the thoracolumbar segment in small dogs. The clinical picture is dominated by progressive proprioceptive ataxia with varying degrees of tetraparesis or paraparesis. The diagnosis of the lesion involves the use of myelography or CT-myelography to identify and locate the intradural arachnoid diverticulum. However, the gold standard method is represented by the MRI exam that determines the degree of damage to the spinal cord, as well as the identification of associated conditions.

Usefulness of Myelography and Computed Tomographic Myelography in Planning for Lumbar Surgery

Usefulness of Myelography and Computed Tomographic Myelography in Planning for Lumbar Surgery

The Role of Steroid in Post Myelography Headache

Myelography is a diagnostic procedure to indicate spinal defects. After the inception of new means of spinal cord imaging, use of myelography has been limited. Since there are contraindications for other modalities in some patients, we have to use myelography. The most common complication of myelography is post myelography headache (PMH). Many methods have been proposed to alleviate the pain. In this clinical trial study we assess the role of steroid in PMH.

Mielografia em ouriço-cacheiro (Sphiggurus villosus)

Relata-se o procedimento de mielografia em um ouriço-cacheiro Sphiggurus villosus, adulto, procedente de vida livre. Após o exame e com o animal sob anestesia geral, evidenciou-se um desvio dorsal do contraste na altura da sétima vértebra torácica (T7), causado por compressão em região ventral dessa vértebra, sugestivo de edema ocasionado pela hemorragia intramedular secundária ao trauma sofrido pelo animal em vida livre. Assim sendo, a mielografia em ouriço-cacheiro mostrou ser bastante válida e eficiente ao apresentar como vantagens a maior precisão para delimitar e localizar a lesão presente na coluna vertebral.

Usefulness of myelography with multiple views in diagnosis of circumferential location of disc material in dogs with thoracolumbar intervertebral disc herniation.

The usefulness of myelography with multiple views (lateral, ventrodorsal, left and right oblique view) in the diagnosis of the exact circumferential location of herniated disc material around the spinal cord in 80 dogs diagnosed with thoracolumbar intervertebral disc herniation at surgery was assessed by comparison of clinical and surgical findings. The circumferential location of the compressing mass was diagnosed in 94% of dogs on myelography. The oblique view was of more benefit than the ventrodorsal view in diagnosing the circumferential distribution of the compressing mass. Only the oblique view contributed to a diagnosis of lateralization of the compressing mass in 45% of dogs. Fourteen percent of dogs had clinical lateralization contralateral to myelographic lateralization. The myelographic localization agreed with the surgical localization in 97% of dogs with regard to the exact location of herniated disc material. The presence of clinical lateralization contralateral to myelographic lateralization and a high proportion of agreement of myelographic and surgical localization documents that myelography with multiple views is useful and essential to accurately determine the circumferential location of disc material around the spinal cord.

Needle diameter in outpatient myelography: rates of adverse effects and current practice trends.

Telephone calls were made to 1251 consecutive patients one day following outpatient myelography. Data were available on 518 patients punctured with 22-gauge (g) (large-diameter) and 465 with 25-g (small-diameter) spinal needles. We surveyed 48 academic and private practice groups regarding needle diameter use in myelography; data were obtained from 34 private practice and 14 academic radiology departments. Patients reported adverse effects including mild and severe headache, back pain and nausea. The percentage of total adverse effects was significantly greater in the 22-g than in the 25-g needle group. The percentage of patients with headache was higher in the 22-g than in the 25-g group, but this difference was not statistically significant. Only 19% of private practice groups and 17% of academic centers use 25-g needles; the remainder use 20-g or 22-g needles.

Inadvertent intraoperative myelography with hypaque: Case report and discussion

Myelography is routinely performed safely using nonionic water-soluble radiographic contrast media. However, inadvertent introduction of ionic contrast media into the thecal space can result in a syndrome of spasms and convulsions, which can lead to death if not recognized and dealt with in a timely manner. We report a case of inadvertent use of the ionic diatrizoate meglumine, an ionic contrast agent, instead of a nonionic contrast agent during intraoperative myelography. The patient developed a sterotypical syndrome of ascending myoclonic spasms, resulting in rhabdomyolysis. Treatment included elevation of the head, removal of cerebrospinal fluid, administration of anticonvulsants, diuresis and sedation, and neuromuscular blockade. The patient recovered well, and there were no long-term sequelae. Intrathecal introduction of ionic contrast media and the resultant syndrome must be recognized promptly and treated with aggressive medical management to address rhabdomyolysis and seizures. Ionic contrast media should be stored and marked in such a way as to avoid inadvertent use in myelography.

Early diagnosis and treatment of spinal epidural metastasis in breast cancer: a prospective study.

This prospective study evaluated the usefulness of myelography in breast cancer patients who present with radiculopathy or myelopathy. A total of 124 consecutive myelograms were performed in 100 patients. Epidural metastasis (EM) was diagnosed in 67 myelograms (54%). Multiple epidural metastases were diagnosed in 15 (22%) of those, resulting in a total of 87 epidural lesions. A complete block was found in 13 EM (15%) and an incomplete block in 14 EM (16%). Clinical data could not predict the site of EM in 29 cases (33%). Fifteen asymptomatic EM were detected in myelograms with multiple EM. Plain radiographs were of no value in determining the site of EM in 29 cases (33%), including 13 cases (15%) without vertebral metastasis at the site of EM. Treatment consisted of radiotherapy (RT) with or without systemic treatment in 52 cases (80%), systemic treatment alone in 11 cases (17%) and surgery in two patients (3%). Clinical improvement was noticed in 72%, no change in 13%, and deterioration in 15%. No difference in response was noticed between RT and systemic therapy. Before treatment 21% and after treatment 15% of the patients could not walk. The one year survival was 42%. The ambulatory status at presentation was the most important prognostic factor. Examination of the spinal fluid, obtained at myelography, disclosed meningeal carcinomatosis in 9% of the patients. Imaging of the whole spinal canal with cytological examination of the spinal fluid is recommended in breast cancer patients suspected of epidural tumour with features of radiculopathy or myelopathy, irrespective of further clinical data and plain spinal radiographs.

A review of the usefulness of myelography in 50 dogs.

Fifty dogs showing clinical signs of spinal disease were investigated by myelography, using iopamidol. In 27 cases the technique was considered worthwhile. Of the 19 dogs not subjected to surgery or euthanasia as a result of the findings, three suffered seizures during recovery from anaesthesia, eight deteriorated in neurological condition and one suffered permanent respiratory arrest as a result of extensive subarachnoid haemorrhage.

Usefulness of myelography in brachial plexus injuries

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.

Iohexol

Nonionic contrast media have been proven safe for intrathecal opacification, but adverse effects, including psycho-organic syndrome and asterixis, have been reported and appear more frequently when contrast medium enters intracranial spaces. Using compressed spectral array (CSA), transient, EEG changes can be monitored more efficiently, and bioelectrical neurotoxicities of various contrast media can be better observed. The nonionic contrast medium, iohexol, was evaluated for safety, patient tolerance, and image quality in studies of the higher regions of the spinal canal and intracranial spaces. Fifty-nine patients received iohexol injections while undergoing myelography, cisternography, or ventriculography. Measurements included detailed neurologic examination, blood pressure and pulse rate, EEG, and CSA EEG analysis. Iohexol provided excellent opacification of the craniocervical region and of brain cisterns. It is safe for use in pericerebral spaces and is exceptionally well tolerated by patients. Due to its safety and convenience for use in myelography, iohexol is expected to facilitate the development and use of new neuroradiologic techniques.

Book reviewLumbale Myelographie mit wasserlöslichen Kontrastmitteln (Lumbar myelography with water-soluble contrast media). By LanglotzM., pp. x+279 391 illus., 1981. (Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin (Advances in the field of X rays & nuclear medicine): Diagnostik, Physik, Biologie, Therapie. Ergänzungsband 109 (Supplementary Vol. 109)) (Georg Thieme, Stuttgart/New York), DM.178. ISBN 3–13–5876–01–2

The revival of interest in water-soluble preparations for value for use in myelography was hastened by the introduction during the last ten to 15 years of new and safer products for use in this important investigation. They have proved of particular value in lumbar myelography and although much had been written in the literature it appeared as isolated reports of experiences or communications about small groups, or even single cases.

Complete myelographic evaluation of spinal metastases from medulloblastoma.

Twenty-six patients with medulloblastoma had complete myelography and spinal fluid cytology and tests for polyamine levels in the evaluation for spinal metastases. The nature and location of abnormalities are presented in this report. Metrizamide was demonstrated to be safe and effective for complete myelography in children. The usefulness of myelography in detecting spinal metastases at the time of initial diagnosis (11%) and at the time of first intracranial recurrence (33%) is discussed.

Spondylosis deformans of the lumbo-sacral joint in dogs.

ABSTRACTThe lumbo sacral angle and the relationship between L7 and the sacrum was measured in dogs with and without vertebral osteophyte formation, including some exhibiting evidence of a significant lesion at the lumbo sacral level. It was deduced that these parameters did not vary greatly between the different groups of dogs, and were therefore not helpful in the diagnosis of disease. The use of myelography was also discussed.

Letter: Contrast media for myelography.

To the Editor.— The article by Wiltse et al (231:474,1975) mentions that water-soluble contrast media such as diatrizoate and iothalamate are safe for myelography under certain conditions. Unfortunately, such a statement is subject to potentially dangerous misinterpretation. The referenced articles1-6report that very serious reactions (convulsions, paralysis, shock, and death) can arise when even relatively small amounts of these media are introduced into the subarachnoid space. In view of these serious reactions, we consider all currently available urographic and angiographic media too toxic for use in myelography even when special techniques designed to assure safety are employed.

Book reviewsMyelography. 2nd edn. By ShapiroR., pp. 440, 453 illus., 1968 (Chichester, John Wiley & Sons Ltd.), £11 4s.

The second edition of this first-class book has been completely rewritten and enlarged by new material, which extends its scope to cover most aspects of the radiology of the spine as well as myelography. After description of the various contrast media in clinical use and in the experimental phase, general indications for the use of myelography and advantages and disadvantages of the various methods are discussed.

Cassette holder primarily designed for use in myelography.

It is particularly difficult to obtain good lateral views in myelography, especially when the patient is tilted. After numerous struggles with sandbags and other ineffectual methods of immobilising a cassette, attention was turned to the possibility of designing a mobile cassette holder which could be adjusted to the angle of the patient's spine, and the height above floor level. Further, as is well known, it is sometimes difficult to balance and maintain the column of Myodil at the required level for more than a few moments. If adequate pictures are to be obtained it is essential to have a mobile, easily loaded cassette holder which can be rapidly adjusted to the height and angle of the table. With these points in mind the present cassette holder was designed. As can be seen from Fig. 1 the base is supported on wheels, thus making for mobility, so that the holder can be rapidly wheeled to and from the X-ray table and screening is interrupted for the minimum of time. Easy angulation is achieved by connect...

Abrodil myelography in herniated disk in the lumbar region.

Following the report by Arnell and Lidstrom (1) in 1931 dealing with the use of a water-soluble contrast medium (abrodil) in myelography, this method of examination has attracted ever-increasing attention, and it has been the subject of numerous articles (2–5). The irritant effect of the medium, necessitating spinal anesthesia, restricts its use in myelography to the lumbar spine. The main indication for abrodil myelography is thus herniated disk in the lumbar region, which, according to Dandy (6), occurs at the fourth or fifth lumbar interspace in 98 per cent of the cases. The contrast medium used at the Department of Radiology of Rikshospitalet, Oslo, is a 20 per cent solution of “myelotrast AL,” which is the chemical equivalent of abrodil, i.e., the sodium salt of monoiodo-methane-sulfonic acid. This solution has a specific gravity of 1.130 and a pH of about 6.2. The technic employed at present is based on that described by Lindblom (7) and Klason (8) and is as follows: The patient is placed on a tilti...

Further Observations on the Radiological Diagnosis of Lumbar Intervertebral Disc Lesions

The X-ray diagnosis of lumbar disc lesions has lately attracted a good deal of attention and numerous papers on this subject have appeared. The contributions fall into two categories. There are those papers which deal with myelography, and there are the communications such as Dandy (1942–1944) and Gillespie (1946) which regard the use of myelography as unnecessary in the diagnosis of a prolapsed disc. The present studies permit deductions concerning some of the factors on which a reliable straight X-ray diagnosis will depend. The importance of a detailed examination with accurate centring needs stressing, as in the majority of patients three to eight different views are necessary before reliable information can be gained. Without a detailed examination under supervision of the radiologist, the radiologist's opinion will be of limited value to the clinical examiner, and the orthopædic surgeon may well interpret the films more accurately than the radiologist. The two principal findings in straight radiography of lumbar disc lesions are decreased intervertebral space and hypertrophic fringe formation. Dandy (1942–1944) came to the conclusion that over 50 per cent. of his cases can be diagnosed on straight radiography. Similar results were obtained by Gillespie (1946). The study of further cases confirms findings such as the frequency of hypertrophic fringe formation. The 31·2 per cent. of cases showing evidence of decreased intervertebral space can be regarded as a conservative figure and this sign alone may be observed in up to 45 per cent. of all cases with prolapsed disc.

THE IMMEDIATE AND LATE EFFECTS OF THE INTRATHECAL INJECTION OF IODIZED OIL

Although generally recognized as a valuable adjunct in the diagnosis of lesions of the spinal cord, myelography by means of iodized oil 1 has been criticized on three scores, namely that it is irritating to the spinal meninges, that it may not demonstrate early lesions and that occasionally it shows a block where no lesion can be found at operation. The first of these, the irritating effect, has been emphasized more than the other objections. 2 The majority of reports have stressed the immediate reactions, but a few have mentioned delayed deleterious effects from the injected iodized oil. The increased use of myelography with iodized oil as a diagnostic aid in the sciatic syndrome has made imperative a comprehensive examination of the immediate and late effects of the intrathecal injection of iodized oil. In order to assess these reactions, we reviewed all the cases at the University of Chicago Clinics