metrizamide and Back-Pain

The functional lumbosacral myelography including the dorsolumbar region was performed on 2,000 cases which are described. The side effects are shown. Three principal groups are discussed: (1) myelographies with 10 ml Metrizamide, (2) myelographies with 15 ml metrizamide (3) remyelographies with metrizamide.

Topics: Adolescent; Adult; Aged; Back Pain; Child; Female; Humans; Male; Metrizamide; Middle Aged; Myelography; Retrospective Studies

Extradural sacral (caudal) block was performed in 17 cases (14 patients) of chronic low back pain. In each case 22 ml of a bupivacaine/methylprednisolone solution incorporating a radioopaque dye was injected over a 2-min period. Patients were randomly assigned to receive the injection in the horizontal position or with 15 degrees head-up or head-down tilt applied to the operating table. Results indicate that analgesia is usually more localised than spread of solution determined by x-ray evidence and that higher levels of analgesia are achieved in patients in the head-up position. Possible causes are the differing distribution characteristics of the constituents of the solution and the gravitational effects of posture on cerebrospinal fluid mechanics. Technical problems associated with obesity, congenital abnormalities, vascular uptake of solution, and delayed spread of the injectant due to adhesions are discussed.

Topics: Anesthetics, Local; Back Pain; Humans; Metrizamide; Nerve Block; Posture; Radiography; Sacrococcygeal Region; Solutions; Spinal Cord

At the orthopaedic clinic in Ratingen we investigated between November 1976 and May 1977 60 patients who were suffering from low back pain by means of myelography in order to verify the type of pathology. As contrast medium we used Metrizamid. All X-rays showed a clear outline of the spinal canal and the roof sheat. In 39 cases out of 60 a prolapsed disk was found. In 9 cases the result was uncertain and the rest was negative. Operation was carried out on 42 patients and the findings in 37 cases were conclusive. No severe side effects were found which were due to the contrast medium.

Topics: Adult; Aged; Back Pain; Clinical Trials as Topic; Drug Evaluation; Female; Humans; Lumbar Vertebrae; Male; Metrizamide; Middle Aged; Myelography; Thoracic Vertebrae

The effect of dehydration on the incidence of side effects from metrizamide myelography was studied. One hundred consecutive patients scheduled for myelography fasted overnight and were then randomly divided into two groups. Group I received 2 liters of fluid intravenously just prior to myelography; Group II did not. Both groups were studied in the standard manner, using 170 mg l/ml of metrizamide. Side effects were recorded 24 and 48 hours after the procedure. Headaches, vomiting, and some other side effects were less common and less severe in the hydrated group. Clear liquids given orally or intravenous fluids are recommended prior to myelography to minimize side effects.

Topics: Adolescent; Adult; Aged; Back Pain; Child; Dehydration; Dizziness; Female; Headache; Humans; Male; Metrizamide; Middle Aged; Myelography; Nausea

The case is presented of a patient showing multiple subcortical haemorrhages after lumbar metrizamide myelography. This complication after intrathecally administered metrizamide contrast medium appears not to have been reported before. Several different possible explanations are proposed for the phenomena observed in this case.

Topics: Back Pain; Cerebral Hemorrhage; Electroencephalography; Epilepsy; Hemiplegia; Humans; Lumbosacral Region; Male; Metrizamide; Middle Aged; Myelography; Tomography, X-Ray Computed

This prospective study evaluated the relative value of lumbar roentgenograms, metrizamide myelography, and discography in identifying structural sources for chronic low-back syndrome. One hundred and eight patients with chronic low-back syndrome were evaluated. Patients had not previously had pathology identified which could explain their pain. On discography, 83 patients (78%) had their pain reproduced at least one abnormal level, identifying a structural component to their pain. Only 22 patients (21%) had all levels of pathology identified by roentgenograms and an additional 17 (16%) had pathology appropriately identified by a combination of myelograms and roentgenograms. Using roentgenograms, myelography, and discography, organic pathology was identified which could explain the patient's symptoms in 100 of 108 patients (93%). Based on this study, we think discography is an important diagnostic tool for use in evaluating patients with chronic low-back syndrome. Discography is essential to adequately identify abnormal levels in patients being considered for fusions. Roentgenograms and myelograms are inadequate evaluation in this chronic pain group in that lack of organic pathology cannot be assumed in the presence of normal roentgenograms and myelograms.

Topics: Adult; Aged; Back Pain; Humans; Intervertebral Disc; Lumbar Vertebrae; Male; Metrizamide; Middle Aged; MMPI; Myelography

Topics: Arthritis, Rheumatoid; Back Pain; Female; Humans; Joints; Metrizamide; Middle Aged; Myelography; Sciatica; Synovial Cyst; Tomography, Emission-Computed; Tomography, X-Ray Computed

Several kinds of the lumbosacral nerve root anomalies have already been recognized, and the conjoined nerve roots is the most common among them. It does not make symptoms by itself, but if there is a causation of neural entrapment, for example, disc herniation, lateral recessus stenosis, spondylolisthesis, etc., so called "biradicular syndrome" should occur. Anomalies of the lumbosacral nerve roots, if not properly recognized, may lead to injury of these nerves during operation of the lumbar spine. Recently, the chance of finding these anomalous roots has been increased more and more with the use of metrizamide myelography and metrizamide CT, because of the improvement of the opacification of nerve roots. We describe the findings of the anomalous roots as revealed by these two methods. They demonstrate two nerve roots running parallel and the asymmetrical wide root sleeve. Under such circumstances, it is important to distinguish the anomalous roots from the normal ventral and dorsal roots.

Topics: Adult; Back Pain; Female; Humans; Intervertebral Disc Displacement; Male; Metrizamide; Middle Aged; Myelography; Nerve Compression Syndromes; Spinal Nerve Roots; Spinal Osteophytosis; Spinal Stenosis; Tomography, X-Ray Computed

Recognizing that not all patients with low back pain have lumbar disc disease, the authors began to inject facet joints in June 1982 and have experience now with 21 patients, each injected under fluoroscopic control with a mixture of local anesthetic and steroid. One technical problem occurred when large osteophytes blocked access to the facet joints. Otherwise, there were no complications and minimal morbidity. Most patients (15 of 20; 75%) had an initial response, but a much smaller number (six of 18 followed more than three months; 33%) had a lasting response. Repeat injections, when done, always led to temporary improvement but rarely to lasting relief (one of five; 20%). Three factors characterized the patients: a negative screening examination for other causes of back pain or sciatica; back pain with tenderness localized over one or more facet joints; and radiologic changes of degenerative joint disease within the facet joints. Facet joint disease may be a significant cause of low back pain. The above three criteria are useful in clinical identification of patients with this problem. Facet joint injections play an important role in the diagnosis and treatment of low back pain.

Topics: Adult; Aged; Back Pain; Female; Follow-Up Studies; Humans; Injections, Intra-Articular; Lidocaine; Male; Metrizamide; Middle Aged; Radiography; Spinal Diseases

The diagnostic evaluation of patients with previous lumbar surgery presents a problem clinically and radiographically. The authors evaluated radiographically 75 patients with previous lumbar surgery who had persistent lumbar symptomatology. From their series, they found that a combination of two modalities (1) plain radiographs of the lumbar spine and (2) CT with intrathecal metrizamide and/or intravenous contrast provided the most complete and useful diagnostic information. The findings are presented with an emphasis on the pathologic changes demonstrated on the CT scans of the lumbar spine of which the most persistent findings were granulation tissue at the surgical site, lumbosacral spondylosis, recurrent or residual herniated disc, and arachnoiditis.

Topics: Adult; Aged; Arachnoiditis; Back Pain; Female; Granulation Tissue; Humans; Intervertebral Disc Displacement; Laminectomy; Lumbosacral Region; Male; Metrizamide; Middle Aged; Myelography; Postoperative Complications; Postoperative Period; Recurrence; Spinal Osteophytosis; Spine; Tomography, X-Ray Computed

Topics: Back Pain; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Methods; Metrizamide; Myelography

CT has become the imaging modality of choice for diagnosing the specific cause of low back pain syndrome. This article describes and illustrates those abnormalities commonly associated with low back pain: disk herniation, spinal stenoses, facet joint abnormalities, spondylosis, inflammatory conditions of the lumbar spine, and sacroiliitis.

Topics: Adolescent; Aged; Back Pain; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Metrizamide; Sacroiliac Joint; Spinal Diseases; Spinal Stenosis; Spondylolisthesis; Spondylolysis; Tomography, X-Ray Computed

Inadequate low back care has now been clearly identified as perhaps the greatest single waste of health care resources in the United States. Low back care failure represents a particularly frustrating and challenging entity. Statistics suggest that 25,000 to 50,000 FBSS cases occur each year. This is a public health problem that should be of the highest level of concern. Modern understanding and technical prowess allow us to study past therapeutic failures and thus gain the knowledge necessary to do better in the future. We sincerely hope that our colleagues will give careful consideration to the material presented here.

Topics: Arachnoiditis; Back Pain; Chymopapain; Humans; Laminectomy; Metrizamide; Patient Care Planning; Postoperative Complications; Tomography, X-Ray Computed

Between 1978 and 1982, 45 patients (44 adults, 1 child) with lumbar isthmic spondylolisthesis (SPL) were operated upon, through a classical posterior approach without setting or fixing. 46 SPL were at the L5-S1 level, 9 at the L4-L5, with 31 class I and 14 class II SPL, according to Meyerding. All the patients had experienced backache with radicular pain. A bilateral interlaminar way with preserving the posterior arch, allowed a large dural and radicular decompression. At the slipping level the wedge-shaped bone was removed while stripping off the disc together with its cartilaginous layer. Every possibility of root compression was cleared up: fibrosis, soft discs, osteophytic spurs, roof of the intervertebral foramina, with exploration of the adjacent levels. Neither bone graft or metallic devices were used. Apophyseal joints and their synovial membrane were denervated by coagulation. The postoperative course was uneventful. Bracing was needed for 2 months. X-ray postoperative follow-up demonstrated an important narrowing of the intervertebral space with constitution of a solid intersomatic fibrous joint without increase of slipping. Good and excellent results were obtained in 68% of cases, fair result in 20% with A 1 to 4 years follow-up. 80% of patients returned to their pre-operative occupation. After reviewing the data of the literature the authors ascertain that more complicated and sophisticated procedures do not bring out better results. They conclude that their safe and simple technique should be widely advocated for lumbar class I and II spondylolisthesis.

Topics: Adult; Back Pain; Child; Female; Humans; Lumbar Vertebrae; Male; Methods; Metrizamide; Nerve Compression Syndromes; Spinal Nerve Roots; Spondylolisthesis; Tomography, X-Ray

Topics: Aged; Back Pain; Diagnosis, Differential; Female; Humans; Lymphoma, Large B-Cell, Diffuse; Metrizamide; Myelography; Neoplasm Invasiveness; Spinal Canal; Spinal Neoplasms; Thoracic Vertebrae; Tomography, X-Ray Computed

One hundred patients with symptoms of lumbo-sacral root compression were prospectively and consecutively assigned to operation based alone on clinical findings. A preoperative myelogram was performed in all patients and described without a knowledge of the clinical features. All patients were explored for the clinically and myelographically relevant disc. When the myelogram was normal (16 patients) both lower lumbar interspaces were exposed. In 58 patients a herniated disc was revealed at surgery. Only "myelographic herniation" with indentation of the contrast column was accompanied by a high frequency of disc herniation at surgery (73-87%). In cases with normal myelograms only 5% had a disc herniation. The severity of the myelographic finding was clearly correlated to the frequency of positive surgical findings and good outcomes. The preoperative radiculogram gives a high degree of certainty in the preoperative evaluation whether a surgical lesion is present or not and reveals a precise prediction of the outcome of surgery.

Topics: Back Pain; Humans; Intervertebral Disc Displacement; Metrizamide; Myelography; Prognosis; Prospective Studies; Sciatica; Spinal Nerve Roots

Topics: Back Pain; Humans; Lumbosacral Region; Metrizamide; Myelography; Sciatica

The development of metrizamide, a recent hydrosoluble contrast medium, has opened up the possibility of dynamic lumbosacral radicolugraphy, but in the opinion of the authors only the upright position is adequate to accentuate or reveal new pathological appearances. This was the case in 68 out of 100 consecutive radiculographies performed.

Topics: Back Pain; Humans; Lumbosacral Region; Metrizamide; Middle Aged; Radiography; Sciatica