Myelography in patients with acquired immuno deficiency syndrome

Summary Neurological complications in patients with Acquired Immuno Deficiency Syndrome (AIDS) are frequent and in addition to central nervous system syndromes, involvement of the peripheral nervous system is increasingly seen. We evaluated the indications and results of myelographic examination in six AIDS-patients with signs of peripheral nervous system disease, out of 200 AIDS-patients with neurological complications. Five of these patients had a polyradiculopathy, with proven cytomegalovirus (CMV) infection in four cases. There were two abnormal myelographic examinations with findings of cauda equina nerve root involvement, both in patients with proven CMV-polyradiculopathy. These abnormal findings had no direct therapeutic consequences. Myelography is not essential for establishing the diagnosis, which is based on cerebrospinal fluid (CSF) analysis, but may be indicated to exclude a spinal cord or nerve root compressive lesion.     

Tolerance of iohexol, iopamidol, and metrizamide in lumbar myelography

Iohexol and iopamidol, two new nonionic contrast media, have been extensively studied in comparison with metrizamide for lumbar myelography. Review of the literature with statistical analysis indicates both agents are superior to metrizamide in terms of number of patients with adverse reactions (p < 0.001). Preliminary data suggest, but do not prove, that use of iohexol may result in fewer side effects than iopamidol.     

Syringomyelia after decompressive laminectomy for cervical spondylosis

We describe a case of cervical spondylotic myelopathy in which deterioration occurred a month after decompressive laminectomy. Syringomyelia was then in evidence as seen by myelography and delayed metrizamide computed tomography scanning. The etiology of this finding and its possible relation to the course and treatment of cervical spondylotic myelopathy are discussed.     

脊髓碘水造影和CT扫描的对比分析(附50例脊髓压迫症资料)

本文报告50例经手术证实的脊髓压迫症,术前全部做过脊髓碘水造影,其结果与手术符合率为94.0％。其中31例联合CT扫描,与手术符合率为96.8％。本文重点讨论脊髓碘水造影和CT扫描对脊髓压迫症的诊断价值,并提出以下几种情况应联合CT扫描:①髓外病变致椎管完全阻塞,造影不能显示其上界;②颅底畸形旨在了解有无其它合并症;③临床高度怀疑脊髓压迫症,但造影未发现明显异常者,④造影提示髓内占位性病变者。     

腰骶神经根管非骨性段狭窄的动态影像学与临床研究

对临床具腰腿痛并脊髓造影显示单或双侧腰骶神经根影中断者，做了椎管斜位伸屈造影（３５例）和动态ＣＴＭ扫描（１３例），观察了根影动态变化。其中１７例术中加用伸屈腰椎拱桥探查了椎管前外侧角与神经根间关系。上述研究结果结合临床症状、体征发现：Ｌ５、Ｓ１神经根受椎管非骨性段挤压机会显著高于Ｌ４神经根。分析认为：常遇的腰骶神经根中断多发生在非骨性段的椎管前外侧角，椎间盘与黄韧带退变是神经根受压的主要病理因素，症状可随体位变动减轻或加重。斜位椎管造影和动态ＣＴＭ对判断不同狭窄节段与指导手术有重要参考价值。     

胸腰椎外伤后脊髓损伤CT平扫的局限性

目的：探讨CT平扫诊断胸腰椎外伤后脊髓损伤的局限性。方法：收集近7a来48例胸腰椎外伤的CT平扫结果、X线片结果及临床资料，并进行对比分析。结果：48例胸腰椎外伤病人中椎体骨折73个，单发59个，多发14个，其中CT示碎骨入椎管内的有25处，血肿1处，附件骨折36处，X线片漏报附件骨折16处(44％)瘫痪病人11例，均经手术治疗，术中发现椎管内碎骨15处，血肿2处，脊髓挫伤或断裂10处。结论：CT平扫对椎体、附件骨折、椎管形态改变和碎骨片移位及明显的椎管内血肿的诊断，优于X线平片，但是对脊髓损伤的显示有局限性，建议胸腰椎外伤后瘫痪病人做脊髓造影(CTM)或磁共振成像(MRI)。     

腰椎间盘突出症的诊断问题──临床检查、脊髓造影、CT及MRI在诊断中所起的作用

本文分析了手术治疗的１５３例腰椎间盘突出症，指出临床检查是诊断本病的基础；各种影象学检查对术前准确定位和鉴别诊断是非常必要的，但是，其结果一定要与临床相结合，才有实际意义。同时讨论了脊髓造影、ＣＴ及ＭＲＩ检查的选择应用和应注意的问题。     

Computed tomogram myelography in cervical spondylosis

Summary Nine patients with severe and prolonged signs and symptoms due to cervical spondylosis had myelography followed by a CT Scan using the same injection of intrathecal contrast. All patients had radiographic changes of cervical spine degeneration and were being considered for exploration and fusion of the anterior cervical spine. All patients had a full clinical evaluation, EMG studies and plain radiographs taken prior to their CT Scan. EMG readings showed several levels of compression in three patients but did not indicate a single level in any. Plain radiography showed multiple level involvement in every patient. Myelography indicated significant indentation in three of five patients with clinical signs but did not demonstrate root cut off in any case. CT Myelography indicated the degree of Lushka and facet joint involvement, indentation, exit foramen encroachment, and the degree of spinal stenosis at the involved segment. In three patients, the findings at operation correlated closely with the CT Scans. Myelography failed to indicate the presence of significant osteophytes in these two cases.

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Résumé Neuf cas d'arthrose cervicale, à l'origine de symptômes sévères et prolongés, ont été étudiés par myélographie couplée à un examen tomodensitométrique en utilisant la même injection de produit de contraste. Dans tous les cas existaient des signes radiologiques de cervicarthrose et les patients étaient programmés pour un abord antérieur du rachis cervical en vue d'une arthrodèse intersomatique. Tous avaient un bilan clinique, électromyographique et radiographique complet avant l'examen tomodensitométrique. L'examen électromyographique a permis dans trois cas de mettre en évidence l'atteinte de plusieurs étages. De même l'examen radiographique a toujours montré une atteinte pluriétagée. La myélographie a visualisé une compression du sac dural dans trois cas sur cinq mais sans jamais révéler l'absence d'injection d'une racine nerveuse. Lorsque la myélographie était couplée à un examen tomodensitométrique les renseignements étaient plus précis: atteinte des articulations de Lushka et interapophysaires, existence d'une compression centrale et/ou latérale. Dans trois cas les constatations opératoires ont confirmé les données de la tomodensitométrie alors que la myélographie seule n'avait pas montré la présence d'importants ostéophytes.

     

CTM诊断腰椎间盘突出症

方法：报告了３６例临床诊断为腰突症患者，均先行脊髓造影后又行ＣＴＭ检查。结果：经手术证实，脊髓造影诊断符合率为８７５％，ＣＴＭ诊断符合率为９６９％。结论：故ＣＴＭ检查诊断准确率较脊髓造影高，且ＣＴＭ对于腰椎间盘膨出或小关节突肥大合并侧隐窝狭窄也有较高的诊断价值。     

Side effects after ambulatory lumbar iohexol myelography

Summary Side effect incidences after ambulatory (22G needle and two h bed rest) and after non-ambulatory (22 and 20G needles and 20 h bed rest) lumbar iohexol myelography have been estimated and compared. Headache incidence was significantly greater in ambulatory (50%, n=107) as compared to non-ambulatory myelography (26%, n=58). Headaches in the ambulatory group tended to be of shorter duration and the difference between severe headaches in ambulatory and non-ambulatory groups was not significant. Serious adverse reactions did not occur and none of the ambulatory patients required readmission because of side effects. The headache was predominantly postural and occurred significantly earlier in the ambulatory group. Headache incidence was significantly greater after 20G needle myelography (44%, n=97) as compared to 22G needle iohexol myelography (26%, n=58). The results supports the hypothesis that CSF leakage is a major cause of headache after lumbar iohexol myelography.