Myelography in the Assessment of Degenerative Lumbar Scoliosis and Its Influence on Surgical Management

Abstract

ObjectiveMyelography has been shown to highlight foraminal and lateral recess stenosis more readily than computed tomography (CT) or magnetic resonance imaging (MRI). It also has the advantage of providing dynamic assessment of stenosis in the loaded spine. The advent of weight-bearing MRI may go some way towards improving assessment of the loaded spine and is less invasive, however availability remains limited. This study evaluates the potential role of myelography and its impact upon surgical decision making.MethodsOf 270 patients undergoing myelography during 2006–2009, a period representing peak utilisation of this imaging modality in our unit, we identified 21 patients with degenerative scoliosis who fulfilled our inclusion criteria. An operative plan was formulated by our senior author based initially on interpretation of an MRI scan. Subsequent myelogram and CT myelogram investigations were scrutinised, with any additional abnormalities noted and whether these impacted upon the operative plan.ResultsFrom our 21 patients, 18 (85.7%) had myelographic findings not identified on MRI. Of note, in 4 patients, supine CT myelography yielded additional information when compared to supine MRI in the same patients. The management of 7 patients (33%) changed as a result of myelographic investigation. There were no complications of myelography of the total 270 analysed.ConclusionMRI scan alone understates the degree of central and lateral recess stenosis. In addition to the additional stenosis displayed by dynamic myelography in the loaded spine, we have also shown that static myelography and CT myelography are also invaluable tools with regards to surgical planning in these patients.

Lumbar Spine Anatomy in Supine versus Weight- Bearing Magnetic Resonance Imaging: Detecting Significant Positional Changes and Testing Reliability of Quantification

“…Increases in the sagittal dimensions observed at the vertebral junctional zones within the spinal canal may have occurred because of dynamic alterations in intra- and intersegmental changes in the vertebral angles, increased apposition of the zygapophyseal joints, and bulging of the interlaminar ligament system with WB, as reported in the literature [ 16 , 17 ]. Such dynamic effects on the lumbar spinal canal with axially loaded spine observed with computed tomography–myelography and MRI in patients with sciatica have been reported and agree to the findings of this study involving asymptomatic individuals [ 6 , 11 ].…”

Accuracy of Coronal Magnetic Resonance Imaging Diagnosis of Multi-Segmental Lumbar Disc Herniation: A Single-Center Retrospective Analysis

“…For patients with MSLDH, ordinary MRI imaging can diagnose most of the compressed herniated intervertebral discs, but it cannot clear the symptomatic sites of MSLDH. Before the introduction of MRI, three-dimensional imaging and traditional myelography were used to confirm and exclude the responsible lesions [ 7 ]. The use of selective nerve root block (SNRB) can also be used to identify the LDH segment responsible [ 8 ].…”

Evaluation of Safety and Efficacy of Preoperative Coronal MRI-Guided Minimally Invasive Surgery for Cervical Spondylotic Radiculopathy

“…However, the diagnostic accuracy of MRI for CSR is limited. It is unable to display the continuous direction of nerve roots, and it also has a false-negative rate in assessing cervical nerve root compression at the intervertebral foramina [ 9 – 11 ]. In addition to using MRI for diagnosis, computerized tomography (CT) myelography with contrast enhancement is used to confirm CSR [ 12 , 13 ].…”