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Background and Purpose: Lateral decubitus CT myelography (LDCTM) is one of the main studies for the detection of CSF-venous fistulas, but detection of CSF-venous fistulas is dependent on intrathecal contrast attenuation. The purpose of this investigation was to assess the tolerability and technical performance of increased intrathecal doses of myelographic contrast compared with standard doses., Materials and Methods: This is a retrospective series of 24 patients who underwent LDCTM following administration of either 10 or 20 mL of intrathecal iodinated contrast media (300 or 320 mg/mL of iodine content). Patients were scanned in the initial lateral decubitus position and then turned to the contralateral side and re-scanned in the same session. The safety and tolerability of the 20 mL dose was assessed from clinical records. The technical performance of the studies was compared between groups (10 or 20 mL) by measuring attenuation values over the lateral thecal sac at standardized levels. Both the initial scan and the scan after turning the patient to the contralateral side were assessed., Results: No moderate or severe adverse event was recorded in either group. The 20-mL group showed higher attenuation values, which were statistically greater on the second side examined compared with the standard-dose group., Conclusions: Increased volume of intrathecal contrast was well-tolerated and improved the technical performance of LDCTM in this limited series. Further assessment of the safety and impact on diagnostic yield using larger patient cohorts is warranted., (© 2025 by American Journal of Neuroradiology.)

Background and Purpose: There is no consensus on whether patients undergoing myelography should discontinue medications that could lower their seizure threshold. The purpose of this study was to document the most commonly prescribed seizure threshold-lowering medications in patients undergoing myelography and determine whether withholding such medications decreases the incidence of seizures., Materials and Methods: We performed a retrospective observational study of all the myelograms obtained in 2016 at 2 affiliated hospitals. At hospital A, seizure threshold-lowering medications are discontinued before myelography, and prophylactic diazepam is given for all cervical myelograms. At hospital B, seizure threshold-lowering medications are not withheld before the procedure, and medical seizure prophylaxis is not implemented. The seizure threshold-lowering medications the patients were taking at the time of the procedure and postmyelographic seizure incidence were documented., Results: A total of 311 patients underwent myelography during 2016. One hundred eleven patients (36%) were on at least 1 seizure threshold-lowering medication, and 30 (10%) were on at least 2. The most common medications were duloxetine, sertraline, venlafaxine, bupropion, and trazodone. The most common tricyclic antidepressant was amitriptyline. Three patients across both sites had a controlled seizure disorder and were on antiepileptics. None of the patients at either hospital had seizures during or within 3 hours following any of the myelograms during the study period., Conclusions: Continuing seizure threshold-lowering medications during myelography does not increase the risk of seizures. Screening for and withholding seizure threshold-lowering medications are not indicated for routine myelography., (© 2019 by American Journal of Neuroradiology.)

Background and Purpose: Patient preparation for myelography and postprocedural monitoring varies widely between practices, despite published guidelines. Our aim was to examine the current practice variations in discontinuing reportedly seizure threshold-lowering medications before myelography and to assess the reported incidence of postmyelographic seizures., Materials and Methods: An e-mail survey was sent to American Society of Neuroradiology members concerning the number of postmyelographic seizures experienced in the past 5 years, the presence of an institutional policy for discontinuing seizure threshold-lowering medications, and the type of myelographic contrast used. We compared the postmyelographic seizure frequency in the responses., Results: Of 700 survey responses, 57% reported that they do not discontinue seizure threshold-lowering medications before myelography. Most (97%) indicated never having a patient experience a seizure following myelography. The number of postmyelographic seizures between those who discontinue seizure threshold-lowering medications and those who do not was not statistically significant (OR = 2.13; 95% CI, 0.91-4.98; P = .08). Most (95%) reported using nonionic hypo-osmolar agents., Conclusions: Survey results revealed widely variable practices for patient myelography preparation and postprocedural monitoring. We found no difference in reported seizures between those who discontinued seizure threshold-lowering medications and those who did not. In light of our findings, we propose that discontinuing reportedly seizure threshold-lowering medications is not warranted with the current nonionic water-soluble contrast agents and may be potentially harmful in some instances. This work supports revision of existing recommendations to withhold such medications before myelography., (© 2018 by American Journal of Neuroradiology.)

We describe the case of a patient with aseptic meningoencephalitis after intrathecal iohexol injection for myelography and review the previous literature on similar cases of contrast-induced neurotoxicity.

We describe a rare complication of myelography. A subarachnoid filling defect was apparent on the postmyelographic CT but not on conventional myelography. MR imaging performed later showed a spinal subarachnoid hematoma (SSAH), extending from L3 to L5. Lumbar puncture may rarely be a cause for SSAH and is more common in patients with coagulopathy. Significant back pain, paresis, radiculopathy, and even altered consciousness or meningeal signs may herald an SSAH.

Background and Purpose: Diskography is commonly performed to investigate pain of suspected diskogenic origin. Although uncommon, diskitis is a feared complication of this procedure. We reviewed the incidence of diskitis and other infectious complications following diskography in a large busy outpatient practice and discuss technical aspects that may contribute to infection prevention., Methods: We reviewed the electronic records of all diskograms obtained at our institution during a 12.25-year period, looking for all cases of procedure-related infection. All diskograms had been obtained by skilled and experienced procedural radiologists in dedicated spine-injection suites with specialized technical staff., Results: There were 12,634 examinations performed on 10,663 patients for a total of 37,135 disk levels. Of the disk levels, 5981 were cervical; 3083, thoracic; and 28,071, lumbar. Two cases of confirmed lumbar diskitis and no cases of either cervical or thoracic diskitis were seen in our series. No other infectious complications were found. The incidence of diskitis was 0.016% per examination and 0.0054% per disk level., Conclusion: In skilled and experienced hands using proper technique, diskography is a safe outpatient procedure with an extremely low incidence of diskitis and other procedure-related infections.

The side effects in myelography are well known and frequently observed. The most common are headache, nausea, and vomiting. In this study, a rather new compound, Thiorphan, was examined, which displays an antinociceptive activity by inhibiting enkephalinase activity. Forty-two patients received intravenous infusions of Thiorphan before myelography. Another 42 patients were in a control group, and Thiorphan was not administered. In the treated group, postmyelographic headache was found in 24% (versus 52% in the control group). Nausea and vomiting were never seen. Low back pain or sciatica was diminished in 33% of cases. Enkephalin levels in cerebrospinal fluid were measured by a radioreceptor-assay method in both groups without any correlation.

Adhesive spinal arachnoiditis is a rare condition of several causes, including complications of myelography. An experiment was conducted to study the effects of surgical glove powder contamination in the cerebrospinal fluid. The subarachnoid space of 45 rabbits was injected with either a suspension of powder from sterile surgical gloves, Pantopaque (iophendylate), or a combination of the two agents. Mild to severe arachnoiditis was produced in 10 of 17 animals injected with the combination of powder and Pantopaque. Only two of 16 rabbits injected with glove powder and one of nine with Pantopaque had more than minimal changes of arachnoiditis. Three rabbits (two injected with glove powder alone and one with both agents) died of meningitis within 1 week of injection. The combination of glove powder and Pantopaque is synergistic in producing arachnoiditis. These results emphasize the importance of meticulous technique in myelography.

Clinical reports have suggested that myelography and laminectomy may produce more arachnoiditis than myelography alone. The effect of experimental lumbar myelography and laminectomy on arachnoiditis in monkeys was studied. Arachnoiditis was as severe after myelography alone as after myelography and laminectomy. Minimal arachnoiditis was found myelographically and histologically after myelography with metrizamide 300 mg l/ml, and severe arachnoiditis was found after myelography with iophendylate whether or not laminectomy was performed. Laminectomy alone produced insignificant arachnoid changes. Experimental myelography preceding laminectomy did not increase the risk of arachnoiditis.

A modified technique for performing Amipaque myelocisternography is described and results obtained in the first 100 patients are analyzed. Diagnostic quality examinations were obtained in 90% of patients in whom the technique was employed. The complication rate was comparable to studies using C1-C2 puncture and to other reports using Amipaque contrast medium. This examination is valuable for high cervical and craniocervical junction lesions, cervical cord atrophy or enlargement, cerebellar ectopia, lower cranial nerve neuropathies, and cerebellopontine angle problems, especially the early detection of small acoustic neurinomas.