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Contrastographic techniques with intrathecal injections (SRG, Myelo-CT) are widely employed in the diagnostic approach to lumbar pathologic conditions. These techniques allow pathologic changes to be demonstrated and the information they yield helps plan the correct surgical approach. However, these invasive examinations are seldom employed for the high incidence of side-effects. The latter are related to various causes, the identification of which can help reduce the side-effects themselves. The authors analyzed a study population of 522 patients subjected to radiculography, using needles of different gauges (18-23 G), and injected non-ionic contrast medium in doses ranging 5-10 ml. The incidence of side-effects was significantly higher in the patients suffering from usual headache (79/237 = 33%), in those under 40 (87/238 = 37%), and in female patients (86/221 = 39%). The incidence of side-effects was lower with fine needles (41/139 = 17%) and contrast medium in doses less than 8 ml (80/337 = 24%). The patients were divided into 4 subgroups according to the different doses of contrast medium administered and to needle gauges: the above parameters exhibited a percentage decrease (21/161 = 14%) with 21-23 G needles and 8 ml of contrast medium. The authors believe it possible to reduce side-effects by using fine needles and smaller doses of contrast medium.

The appearance of side effects was monitored in 70 selected patients who underwent radiculography and myelography. After the examination, a rapid return to normal activity was recommended. In accordance with literature, no greater incidence of side effects was found in patients who were allowed to get up soon after myelography or radiculography, than in patients confined to bed for some hours. These results are essentially attributable to the low toxicity of the contrast medium used in this study (Iopamidol), and to an adequate hydratation of the patients after examination.

The incidence is reported of postural headache and other types of headache arisen after myelography in a pilot sample of 540 patients, divided into 3 groups. The myelographic study was performed on the first two groups using 20 and 22 gauge needles, and with 25 gauge needles on the third group. 140 patients in the third group were treated on an outpatient basis, and 25 of them underwent myelo-CT. Myelography was performed on all the patients in the second and third group in erect position. In the authors' opinion, the erect position and the use of a fine needle determined a considerable reduction in post-myelographic side effects, i.e. postural headache.

610 sacrorodiculographic and myelographic examinations were carried out injecting at lumbar level Iopamidol at 200, 300 and 370 mg I/ml concentrations. Immediate and early complications have been noticed in 18,52% of cases, i.e. sensation of pain during contrast injection, headache, nausea, vomit, neck stiffness, photophobia, epilepsy. In sacrorodiculographic examinations, side effects especially occurred by using 370 mg I/ml concentrations; in lumbar and thoracic myelographies, incidence of complications did not statistically differ by uing 300 or 370 mg I/ml concentrations. Side effects have occurred most frequently in cervical myelographies carried out with 370 mg I/ml concentration. Analysis of complications as well as radiographic results suggest to use Iopamidol at 300 mg I/ml concentration in sacrorodiculographics, in lower thoracic myelographies and in studies of narrowed, stenosed or obstructed canals; Iopamidol at 370 mg I/ml concentration may be used in upper thoracic studies and cervical myelographies.

Attention is called to the risks of gas myelography and two cases of complications are described. One of these, observed personally, was fatal and its possible pathogenetic mechanisms are illustrated. Stress is laid on certain rules and precautions that should be respected in radiological and anaesthesiological practice. Insufflation pressure and volumes of injected air deserve particular attention and scrupulous intraoperative control cut of vital parameters must be carried and appropriate attention paid to patient hydration during the postoperative period.