iothalamate-meglumine and Intervertebral-Disc-Displacement

Magnetic resonance discography using gadolinium as an intradiscal contrast agent was investigated in a prospective study.. To evaluate the utility of magnetic resonance discography using gadolinium as an intradiscal contrast agent, as compared with the current standard of computed tomographic discography using intradiscal iodinated contrast agent.. Magnetic resonance arthrography with gadolinium has been used to evaluate shoulder, elbow, wrist, hip, knee, and other joints. Gadolinium has not been used as an intradiscal contrast agent. The authors' preliminary results using gadolinium as an intradiscal contrast agent for magnetic resonance discography were reported previously. They report the results of their completed study.. For this study, 42 disc levels were studied in 13 patients. Water-soluble iodinated contrast and gadopentetate dimeglumine were injected at each disc level. After discography, anteroposterior and lateral radiographs, computed tomography scans, and T1-weighted magnetic resonance imaging were performed. Six physicians interpreted the results from each disc level in a blinded fashion. Interscan and interobserver interpretation variability was determined for magnetic resonance discography and computed tomographic discography using the Pearson correlation-coefficient (r) test.. Interscan variability was highly correlated between computed tomographic discography and magnetic resonance discography when used to determine disc normality (r = 0.87), general degeneration (r = 0.87), anular fissure (r = 0.89), disc herniation (r = 0.92), and contrast leakage (r = 0.77). Interscan variability was assessed by the Pearson test, and all values of r for all the readers were noted to be statistically significant at P values less than 0.01. Interobserver variability was significantly correlated among the four more experienced readers (neuroradiologists and spine surgeons), but not among the spine fellows. Interobserver variability was also significantly correlated by computed tomographic (CT) and magnetic resonance imaging (MRI) discography for disc normality (CT r = 0.60; MRI r = 0.56), general degeneration (CT r = 0.76; MRI r = 0.71), anular fissure (CT r = 0.79; MRI r = 0.84), and disc herniation (CT r = 0.63; MRI r = 0.64). The readings for contrast leakage did not reach statistical significance for computed tomographic or magnetic resonance discography.. The high interscan and interobserver correlation rates obtained for magnetic resonance discography using gadolinium, as compared with the standard computed tomographic discography technique, indicate that magnetic resonance discography may be an acceptable substitute for the imaging of disc pathology. Magnetic resonance discography with gadolinium can be recommended for patients allergic to iodinated contrast agents and for patients who wish to limit their radiation exposure.

Topics: Contrast Media; Drug Administration Routes; Gadolinium DTPA; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Iothalamate Meglumine; Magnetic Resonance Imaging; Observer Variation; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Spinal Diseases; Tomography, X-Ray Computed

To extent the safety information for Chymodiactin (chymopapain for injection), 37 neurologic and orthopedic surgeons conducted an open-label, multicenter, phase 3 clinical study. A total of 1,498 patients with one or two herniated lumbar intervertebral discs were enrolled. Therapeutic results were generally favorable, with the percentages of patients achieving either excellent or good (or successful) results ranging from 79.6% to 88.9%, depending on criteria employed in the tabulation. There were 13 cases of anaphylaxis, and 2 of these patients died of complications of anaphylaxis. Two additional patients experienced serious neurologic problems. The first of these two patients developed transverse myelitis and paraplegia approximately 3 weeks following chemonucleolysis. Transdural discograms at three levels had been done approximately 2 days prior to chemonucleolysis, in violation of the protocol. The second patient developed acute cauda equina syndrome, and, despite emergency laminectomy, had permanent neurologic sequelae. Back spasm and stiffness/soreness were the most frequently encountered adverse experiences.

Topics: Adolescent; Adult; Anaphylaxis; Chymopapain; Clinical Trials as Topic; Double-Blind Method; Endopeptidases; Female; Follow-Up Studies; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Male; Middle Aged; Radiography; Random Allocation; Spasm

The term "peridurography" stands for visualization of the cavum epidurale via a water-soluble contrast medium. The article reports on the technique and indication. The experience collected on the basis of 93 peridurographies effected by the authors justify the assumption that this method can be considered as reliable in the diagnosis of prolapsed vertebral disk.

Topics: Adult; Clinical Trials as Topic; Epidural Space; Evaluation Studies as Topic; Female; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Male; Radiography; Spinal Canal

Topics: Adult; Aged; Cicatrix; Contrast Media; Diagnosis, Differential; Diatrizoate Meglumine; Evaluation Studies as Topic; Female; Humans; Infusions, Intravenous; Intervertebral Disc Displacement; Iothalamate Meglumine; Lumbar Vertebrae; Male; Middle Aged; Postoperative Care; Postoperative Complications; Predictive Value of Tests; Radiographic Image Enhancement; Recurrence; Reoperation; Retrospective Studies; Sensitivity and Specificity; Single-Blind Method; Tomography, X-Ray Computed

One hundred and thirty-nine discs from cadaveric lumbar spines were injected with a mixture of radio-opaque fluid and dye. Discograms were taken and the discs were then sectioned in the sagittal plane. Examination of the sections revealed that injected fluid did not at first mix with the disc matrix but pushed it aside to form pools of injected fluid. The location of these pools, and hence the appearance of a discogram, depended on the stage of degeneration of the disc. It is concluded that useful clinical information can be obtained from discograms.

Topics: Adolescent; Adult; Child; Coloring Agents; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Iothalamate Meglumine; Lumbar Vertebrae; Middle Aged; Radiography; Spinal Diseases

A prospective study of contrast-enhanced computed tomography (CT) scanning was undertaken for 17 levels previously operated upon in the lumbosacral spine in 14 patients. All levels with prior operations were scanned before and after the administration of intravenous contrast medium. A standardized technique for contrast enhancement using high doses of intravenous contrast medium was employed and a specialized technique for measuring enhancement with corrections for scan artifacts was used. Results indicated that measurable contrast enhancement occurred in 16 of 17 postoperative scars up to 12 years after surgery. Enhanced scans provided more accurate delineation of the size and margins of postoperative scarring than precontrast scans. No instances of enhancement of normal disk or recurrent herniated disk were observed. In six instances recurrent herniated disks were predicted on the basis of contrast-enhanced CT scans and subsequently confirmed at reoperation. Contrast-enhanced CT scans meticulously performed appear to permit differentiation between scarring and disk herniation in patients with recurring symptoms after operations for lumbosacral disk disease.

Topics: Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Lumbar Vertebrae; Lumbosacral Region; Postoperative Complications; Prospective Studies; Recurrence; Time Factors; Tomography, X-Ray Computed

There are few reports of hemorrhagic central nervous system complications after chymopapain injection in humans. Two patients are reported who developed hemorrhagic complications after the lumbar injection of chymopapain. The first developed a hemorrhagic encephalomyelopathy followed by clinically suspected acute arachnoiditis, which responded to high doses of dexamethasone. The second patient developed subarachnoid hemorrhage secondary to vertebral artery aneurysm rupture after the injection of chymopapain.

Topics: Adult; Arachnoiditis; Cerebral Hemorrhage; Chymopapain; Diatrizoate Meglumine; Drug Interactions; Endopeptidases; Hemorrhage; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Male; Metrizamide; Spinal Cord Diseases; Subarachnoid Hemorrhage

Twenty-five patients clinically suspected of herniated lumbar disk have undergone a CT examination before and 40 min after contrast enhancement. In every case, 13 of which were surgically verified, significant contrast enhancement of herniated disks was seen; there was only one false positive case. The authors conclude that late contrast enhancement really improves the CT diagnosis of herniated lumbar disk, particularly in cases with a doubtful or negative precontrast scan. The mechanism of the late contrast enhancement is discussed.

Topics: Adult; Aged; Diagnosis, Differential; Female; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Lumbar Vertebrae; Male; Middle Aged; Radiographic Image Enhancement; Sciatica; Tomography, X-Ray Computed

Topics: Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Lumbar Vertebrae; Radiography; Spinal Canal

Topics: Catheterization; Contrast Media; Diagnostic Errors; Epidural Space; Evaluation Studies as Topic; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Lumbar Vertebrae; Metrizamide; Myelography; Spinal Canal; Technology, Radiologic

Three cases developing increasing neurological deficit within 24 hours of lumbar radiculography with Dimer X are reported. All three developed severe low back and sciatic pain, and myoclonic spasms within one hour of the examination. In each a large intervertebral disc prolapse was outlined. Two cases developed near complete paraplegia before surgical decompression. Following surgery, two patients made a complete rapid recovery, and the other has recovered partially.

Topics: Adult; Back Pain; Decompression; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Lumbosacral Region; Male; Middle Aged; Muscle Spasticity; Paraplegia; Radiography; Spinal Nerve Roots; Time Factors

Epidural double-catheter venography may be considered as a most reliable method of demonstrating lumbar disc herniation. In our case material the diagnostic results proved to be more accurate than the results of lumbar myelography, especially when very lateral disc herniations are concerned. In the operated patients the diagnostic accuracy of the venograms was 94% versus a myelographic accuracy of 85%. Systematic use of two catheters and simultaneous contrast injection provides the possibility to obtain homogeneous filling and excellent opacification of the anterior epidural veins at any lumbar level. During the procedure a choice can be made out of over 20 catheter position combinations to obtain good quality venograms. In 40 patients metrizamide (Amipaque) is used as a contrast agent in an iodine concentration of 350--370 mg/ml. This concentration does improve the opacification of the epidural venous plexus, providing better diagnostic information. Metrizamide causes hardly any discomfort to the patient, even when 50--70 ml are injected within 5 sec.

Topics: Catheterization; Epidural Space; Femoral Vein; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Lumbar Vertebrae; Metrizamide; Phlebography; Sacrum; Veins

Topics: Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Radiculopathy; Radiography; Spinal Nerve Roots

After preceding lumbar intervertebral disk operations, 88 Dimer-X myelographies were carried out. The examinations were performed with the patients in a lying position; if required, function pictures were taken in a sitting or standing position. Only in three cases the X-ray findings were unconspicuous. The findings included 12 prolapses at other levels, 6 prolapses, 5 massive scars, one pronounced osteophytosis, two cases of serious reticulitis, two meningoceles and one neurinoma outside the field of operation. The dorsal or lateral narrowing of the contrast band typical of prolapses found in the first dimer-X myelogram were only produced by scars in the renewed operation. The authors warn against pantopaque myelography for lumbar intervertebral disk diagnosis because of proven arachnoidal adhesions. The necessity of surgical procedures avoiding as far as possible tissue damage leaving scars and adhesions is stressed.

Topics: Adult; Contrast Media; Female; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Male; Middle Aged; Myelography; Postoperative Complications; Posture

A study was made of the files 2292 patients examined by sacco-radiculography with watersoluble contrast medium, of whom 340 had been subjected to a second examination. 284 of these had undergone surgery with good results during the interval between the two examinations. In 56 cases, repeat sacco-radiculography was carried out but no operation performed. In both groups of patients a semiological study was made of the radiological appearances to determine which were the effects of the contrast medium and which could be attributed to the operation. The paper concludes with a discussion of the problem of genuine and false albuminoachies of sacco-radiculography using meglumine locarmate (dimer-X).

Topics: Adrenal Cortex Hormones; Dura Mater; Humans; Injections, Spinal; Intervertebral Disc Displacement; Iothalamate Meglumine; Iothalamic Acid; Laminectomy; Myelography; Spinal Nerve Roots; Subarachnoid Space

Experience with Dimer-X myelography in 3000 patients provides some indication of the scope of examination of the lumbar, thoracic and cervical segments of the spinal canal with a water-soluble contrast medium. Myelography with any contrast medium should only be applied for serious indications, and never as an outpatient procedure, for the patient requires careful after-treatment. However, the routine use of myelography may offer the best insurance against the disappointment and embarrassment of surgery by trial and error. The application of a careful, standardized technique makes it possible to obtain accurate information about the whole spinal canal and to avoid the danger of the false results to which examination with oily media are liable at all levels. The development of ever safer contrast media may help to limit the problem of spinal fibrosis, which is not a rare complication of myelography and spinal surgery.

Topics: Child; Female; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Male; Myelography; Premedication; Spinal Diseases; Subarachnoid Space

On the basis of 500 myelogramms carried out with hexaiodated, water soluble, and rapidly absorbable Dimer X, the experiences gained in the diagnoses of damages of the lumbar intervertebral disks are presented. It can be stated that Dimer-X myelography has proved to be very useful for the recognition of space-narrowing processes in the lumbar region. No serious complications were observed. Most of the troubles, including, for example, transitory headache and the like, correspond to those sometimes found after simple lumbar punctures.

Topics: Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Lumbar Vertebrae; Myelography

When comparing myeloscintigraphy with positive myelography (Dimer X) in the diagnosis of the lumbar prolapse of intervertebral disks, identical findings were obtained in 17 out of 24 cases. Of these, both methods showed pathological findings in 12 cases and normal conditions in 5 cases. Only in 5 pathological myeloscintigrams normal Dimer X myelograms were obtained and in 2 myeloscintigrams judged as normal the positive myelograms were pathologic. With a good correlation of the two methods in typical cases the Dimer X myelogram, however, offers the advantage of the possibility of examining in several planes under constant reference to the vertebral column. Owing to the good tolerance, myeloscintigraphy should be used in screening diagnoses and in cases where also thoracic parts have to be included in the examination.

Topics: Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Myelography; Radionuclide Imaging

Topics: Adolescent; Adult; Aged; Female; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Iothalamic Acid; Lumbosacral Region; Male; Middle Aged; Myelography

Topics: Adult; Female; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Iothalamic Acid; Lumbosacral Region; Male; Middle Aged; Myelography; Posture

Myelography supplemented by tomography was routinely carried out in 150 cases. The number of false negative findings was reduced practically to nil. At present, this method is only used in cases with equivocal results at conventional myelography or with poor correlation between clinical symptomatology and myelography. The frequency of side effects in 500 examinations with Dimer-X is unimportant.

Topics: Adult; Aged; Contrast Media; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Myelography; Spinal Nerve Roots; Tomography, X-Ray

The authors report four cases of cauda equina syndrome following Dimer X radiculography. The cases are described and commented upon. The conclusion is that Dimer X is a substrate associated with a certain degree of toxicity. Indications for and technique in sacroradiculography should be rigorous.

Topics: Adult; Cauda Equina; Contrast Media; Erectile Dysfunction; Fecal Incontinence; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Iothalamic Acid; Male; Middle Aged; Myelography; Paraplegia; Urinary Incontinence

Water-soluble contrast radiculography has been used for many years. Earlier contrast media were highly irritant and subjects required preliminary spinal anesthesia but, recently, better-tolerated contrast media such as meglumine iocarmate (Dimer X) and metrizamide (Amipaque) have been used. The findings from 300 examinations with meglumine iocarmate are presented. Methodology is discussed. The diagnostic accuracy of this contrast medium was high and side effects were minimal. Comment is made on the newest spinal contrast medium--metrizamide--and its use in 29 examinations in Canada.

Topics: Contrast Media; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Lumbar Vertebrae; Methods; Nerve Compression Syndromes; Radiography; Spinal Cord Compression; Spinal Nerve Roots

The pre-operative myelograms performed using Dimer-X (dimeglumine-iocarmate) of 219 patients were re-evaluated post-operatively without knowledge of the operative findings. In 77% the myelographic interpretation was in agreement with the surgical diagnosis. The interpretation was difficult and unreliable when only one or few radiographic signs were present. In order to achieve optimal benefit from the investigation the history and clinical findings should also be considered as equally important. Myelography is only justified in clinically unclear cases. In view of this and possible complications a stringent indication in necessary.

Topics: Adolescent; Adult; Female; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Iothalamic Acid; Male; Middle Aged; Myelography

Lumbar radiculographs were obtained in 252 patients with suspected disk herniation. Fifteen patients who underwent previous radiculography with Dimer-X plus Depo-Medrol exhibited adhesive arachnoiditis. This was not observed in 6 patients who received Dimer-X alone. No positive correlation between radiological diagnosis of adhesive arachnoiditis and clinical symptoms can be demonstrated. The authors suggest that steroids not be used intrathecally in combination with water-soluble contrast media.

Topics: Adult; Arachnoiditis; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Iothalamic Acid; Methylprednisolone; Middle Aged; Myelography; Sciatica