Computed Tomography in Low Back Pain before and after Myelography

Abstract

Forty-six patients with possible lumbar disk herniation were examined with computed tomography (CT) before and after lumbar myelography with metrizamide. Altogether 90 intervertebral spaces (L4/LS and L5/S1) were analyzed with regard to the diagnostic information provided by pre-and postmyelography CT. Corresponding to the level of 73 intervertebral spaces (81%) the contrast medium filling of the dural sac was homogeneous, while corresponding to 17 spaces (19%) the filling was inhomogeneous, with layering of contrast medium. The demarcation of the disk margin and of the dural sac was poor at the level of 13 spaces (14%), the majority of which (9 spaces) belonged to the group with homogeneous dural sac filling. At the level of 4 intervertebral spaces the dural sac was isodense with the intervertebral disk. The overall diagnostic information from the premyelography examination was equal to the postmyelography examination at 66 intervertebral spaces (73%). The postmyelography CT examination showed the details better than the conventional CT at 11 intervertebral spaces (12%), and poorer than conventional CT at 13 intervertebral spaces (15%). It is concluded that in general a conventional CT examination is adequate in the evaluation of patients with suggested intervertebral disk herniation. The need for a postmyelography CT examination can be specified on the basis of the findings at myelography.

The development of musculoskeletal radiology for 100 years as presented in the pages of Acta Radiologica

“…In degenerative disease, CT was reported for meniscal evaluation in 1984 (93) and shoulder arthroplasty in 1987 (94). Spinal imaging was reported for diagnosis and postoperative imaging of low back pain and cervical spine spondylosis, comparing it with myelography and MRI (95)(96)(97). Bone trauma imaging was not at the forefront during the early years due to the missing possibility to perform multiplanar reformations (MPR), which is so important today.…”