Cervical radiculopathy: computed tomography and myelography compared

The accuracy of CT in the determination of cervical disk herniation has not been measured as it has in the determination of lumbar disk disease. Cervical myelograms and CT scans of patients with cervical radiculopathy secondary to disk herniation or spondylosis, which was verified by clinical examination, surgery, and in most cases EMG, were evaluated blindly and independently, results were analyzed statistically, and receiver operating characteristic (ROC) curves were calculated. CT without or with the use of intrathecal metrizamide was more accurate than myelography in the identification of lesions that caused cervical radiculopathy. In some patients, CT obviates the need for cervical myelography. With improvement in CT techniques and more experience in interpreting the images, CT will be increasingly important in the evaluation of cervical radiculopathy.     

Cervical disk syndromes: value of metrizamide myelography and diskography

This paper reports on the respective diagnostic values of myelography with water-soluble contrast media and diskography in a study of 100 patients examined between 1979 and 1981 and operated on because of cervical disk disease. The results of the study led to a change of the diagnostic procedures formerly applied in radicular syndromes (i.e., diskography, and then perhaps myelography) and in cervical myelopathy (myelography, rarely followed by diskography). Now cervical metrizamide myelography is always performed first. Diskography is only indicated in radicular syndromes to determine the segment causing clinical symptoms when there is a polysegmental space-occupying lesion on the myelogram in combination with a mono- or oligoradicular neurologic symptomatology; or in the case of a normal myelogram with complaints resistant to conservative treatment.     

Cervical myelopathy: a comparison of magnetic resonance and myelography

Fifty-seven patients with a strong clinical suspicion of cervical myelopathy were studied with body coil magnetic resonance (MR) and conventional myelography or CT myelography. Eight patients were believed to have normal studies with both modalities. There were six patients with syringomyelia; four with an intramedullary tumor; one with an arteriovenous malformation; 19 with cervical spondylosis at multiple levels; eight with cervical spondylosis at a single level; four with extensive rheumatoid arthritis; four with extradural neoplasm; two with trauma; and one patient with an epidural abscess. In this study, body coil MR was the superior examination for the evaluation of an intramedullary process. It was as diagnostic as myelography in one case of an extramedullary intradural lesion. In patients with extradural disease, body coil MR was the superior study in 45%, equivalent to myelography in 37%, and, although still diagnostic, inferior to myelography in 17%. In 8% of the cases, body coil MR was at best equivocal, whereas myelography was diagnostic. It appears that in technically adequate studies, MR is at least equivalent to myelography in its ability to delineate disease. A superior MR study provides a better appraisal of the size and character of the spinal cord as well as the degree of both anterior and posterior defects on the subarachnoid space and neural structures. In addition, MR is as good as conventional myelography for the identification of extrinsic cervical cord lesions producing cervical myelopathy. Finally, an additional small group of 30 patients were studied with a prototype surface coil to determine its advantages relative to body coil imaging. Each patient had correlative myelography. As with body coil MR, imaging with the surface coil was believed to be more informative than conventional myelography in four patients with intramedullary lesions. The remaining 26 patients suffered from cervical spondylosis. Surface coil MR was believed to be more informative than myelography in six cases (23%), equivalent to myelography in 19 (73%), and less diagnostic than myelography in one (4%). The improved spatial resolution with the use of the surface coil was believed to increase the accuracy of MR.     

Cervical and lumbar metrizamide myelography. Split-dose technique

Good- or excellent-quality cervical and lumbar myelograms may be obtained without exceeding the maximum recommended dose of metrizamide and without using special equipment. With the patient's head down, highly concentrated metrizamide was injected via the lumbar approach to opacify the cervical subarachnoid space. Later, with the patient's head up, additional contrast media was used to opacify the lumbar subarachnoid space. Excellent or good cervical and lumbar myelograms were obtained in 18 of 21 instances.     

Theory and practice: how much contrast for myelography?

Summary A questionnaire sent to members of the British Society of Neuroradiologists revealed that the majority of practitioners will, when necessary, inject more than 3 g of iodine during myelography with iohexol or iopamidol. The 3 g limit recommended by the contrast medium manufacturers is not based upon scientific studies involving these media, and it is the experience of British neuroradiologists that larger amounts of modern contrast agents can be used without an increase in post myelography complications. There is, therefore, a need for a controlled trial to assess the question of the most appropriate dose of contrast medium in myelography.     

Risk factors in complications of aqueous myelography.

The adverse reactions from aqueous myelography in 88 primates were reviewed to determine what factors increase the risk of complications. Seventy-four iocarmate (Dimeray) myelograms were obtained on 41 animals, and 90 metrizamide (Amipaque) myelograms were obtained on 47 animals. The risk of seizures and death from iocarmate myelography was higher than from metrizamide myelography. In animals that had previous myelograms or showed evidence of arachnoiditis, the risk of complications from aqueous myelography was higher. Additional precautions may be indicated if aqueous myelography is performed in patients with arachnoiditis.     

Cervical myelography and x-ray computed tomography in arm paralysis of traumatic origin

Results of cervical myelography by the lumbar approach were compared with those of CT scan imaging after subarachnoid metrizamide by the lumbar route, in 16 patients operated upon for post-traumatic cervical spine lesions. Examination in each patient included the last four cervical and first thoracic roots on the injured side, making a total of 80 roots. Lesions detected by myelography and CT scanning are described, comparison of semiologic data with gross findings at operation showing poorer diagnostic accuracy for myelography (86%) than for myelography and a CT scan combined (97%). Sensitivity of the former varied between 70 and 90%, depending on whether doubtful forms were classed as normal or pathologic, but was lower than that of the CT scan (96%). This also applied to specificity (90% as against 96%) and diagnostic accuracy (86% to 90% as against 97%). Combining myelography with a CT scan after subarachnoid contrast injection provides complementary very precise data allowing improved therapeutic results.     

Cervical myelography of nerve root avulsion injuries using water-soluble contrast media

Eight cases of cervical nerve root avulsion injury are presented which were investigated by cervical myelography using a water-soluble contrast medium. The previous literature describes the appearances of this lesion using an oil-based agent and has resulted in emphasis being placed on looking for a traumatic meningocele rather than an abnormality of the roots themselves. The excellent definition of the nerve rootlets and axillary pouch that are obtained with a water-soluble contrast medium resulted in more root lesions per patient being detected than with an oil-based medium. There was complete correlation with the surgical findings at all but one root level explored. The appearances of root avulsion injuries and the advantages of using a water-soluble contrast medium are discussed.     

Cervical myelography via lumbar approach. Simple, reliable and painless technic

A proposal is made to substitute myelography using a lumbar approach for cervical myelography by laterocervical C1-C2 puncture. It is essential for contrast to be injected in procubitus. This examination is simpler to perform, is free from risk and radiologic and diagnostic qualities of images are excellent. This procedure is now used routinely for primary investigation of cervical region and excellent results have been obtained.     

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. Received: 27 March 1998/Accepted: 6 March 1999     

Cervical carcinoma: treatment results and complications of extended- field irradiation

The authors studied treatment complications, recurrence patterns, and survival in 18 patients with histologically proved metastases to the paraaortic lymph nodes from invasive cervical carcinoma treated with extended-field irradiation. Complications following treatment developed in five of 10 patients who underwent transperitoneal nodal biopsy or dissection and in two of eight patients in whom an extraperitoneal approach was used (overall complication rate of 39%); however, only one had a gastrointestinal complication (small bowel obstruction after transperitoneal nodal biopsy and irradiation). Fourteen patients had persistent or recurrent disease within the abdominal or pelvic cavity; only one had distant metastases without recurrence in the abdomen or pelvis. Two of the 14 patients had a recurrence in the surgical scar following extraperitoneal nodal biopsy, possibly due to placement of the scar outside the radiation field. After a minimum follow-up of 48 months, only three of 18 patients (17%) were alive and well.