metrizamide and Scoliosis

Intramedullary spinal cord tumours may present as scoliosis without neurological signs. Those treating spinal deformities should be alert to this possible aetiology. The clinical features of 12 such cases are discussed with reference to early diagnosis and treatment. Patients with a painful scoliosis should be investigated with myelography as well as bone scintigraphy. Many intrinsic spinal cord tumours are now amenable to surgical removal. The prognosis for neurological recovery is poor once a severe deficit becomes established. The importance of early diagnosis and joint orthopaedic and neurosurgical management is emphasised.

Topics: Adolescent; Adult; Astrocytoma; Child; Child, Preschool; Female; Humans; Laminectomy; Male; Metrizamide; Myelography; Retrospective Studies; Scoliosis; Spinal Canal; Spinal Cord Neoplasms; Spinal Fusion; Time Factors; Tomography, X-Ray Computed

A basic and clinical study on the diagnostic value of computed tomographic myelography (CTM) with metrizamide was performed using the GE. CT/T. X-2. A basic study: using the fourth lumbar spine taken from a fresh cadaver and the phantom containing a test tube filled with metrizamide, the optimum window level (W. L.) and window width (W. W.) of the spinal CT and the optimum metrizamide concentration for the CTM were investigated. A clinical study: the relation between the concentration and volume of metrizamide and the timing for performing the CTM after intrathecal injection of metrizamide were examined, then CTM was performed in 82 cases with spinal and spinal cord disorders and 4 cases with normal spinal cords.. 1) Observing the spinal CT and CTM, the optimum W. L. is 50-150 and W. W. is 1,000. 2) The optimum metrizamide concentration of the subarachnoid space for CTM is 6-12 mgI/ml and its CT number is 150-300. This concentration is difficult to recognize in the conventional myelography. 3) It was confirmed that there were two methods to obtain the optimum concentration. One is the CTM after conventional myelography by lumbar puncture; at the cervical or thoracic level CT is performed 1-2 hours after metrizamide myelography with 230-250 mgI/ml and 7-10 ml, and at the lumbar level CT is performed 3-6 hours after myelography with 190-200 mgI/ml and 6-7 ml. The other is the CTM without conventional myelography; at each level, metrizamide with 100 mgI/ml is injected by lumbar puncture and CT is performed 15-40 minutes after injection of 10-15 ml for the cervical or thoracic level, and 3-5 ml for the lumbar level. The CTM obtained under these conditions provides the accurate information about intraspinal canal lesions and, therefore, it is very useful not only for the diagnosis of the lesion but also for the selection of the approach when a surgical treatment is indicated.

Topics: Adolescent; Adult; Aged; Arnold-Chiari Malformation; Cervical Vertebrae; Child; Female; Humans; Lumbar Vertebrae; Lymphoma, Large B-Cell, Diffuse; Male; Metrizamide; Middle Aged; Multiple Myeloma; Myelography; Neural Tube Defects; Scoliosis; Spinal Cord Neoplasms; Spinal Stenosis; Thoracic Vertebrae; Tomography, X-Ray Computed

A retrospective examination was performed to assess the accuracy of metrizamide myelography (MM) and computed tomographic metrizamide myelography (CTMM) in scoliosis. Of 81 consecutive scoliotic children studied by myelography, 30 had only MM while the remaining 51 had CTMM immediately afterward. CTMM added essential diagnostic information in 13 cases of dysraphism and 4 cases of idiopathic scoliosis; in the remaining cases, both methods gave the same information. The authors conclude that in patients with severe scoliosis, dysraphism, and scoliosis with localized neurological disturbances, CTMM should always be added to MM or be the only examination; while in idiopathic scoliosis with vague neurological disturbances a survey of the entire spine is essential, preferably with MM.

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Infant; Male; Metrizamide; Myelography; Neural Tube Defects; Retrospective Studies; Scoliosis; Tomography, X-Ray Computed

Two patients with severe kyphoscoliosis developed marked spinal irritation following myelography with the new non-ionising contrast medium Amipaque. The authors raise the possibility that the spinal deformity may result in reduced flow of cerebro-spinal fluid; this may prolong the contact of the contrast medium with the (previously damaged?) spinal cord. Patients with this type of spinal deformity require particularly stringent indications for the performance of myelography, even when using Amipaque.

Topics: Aged; Female; Humans; Kyphosis; Male; Metrizamide; Middle Aged; Myelography; Scoliosis