Lumbar myelography enhanced with ion free contrast medium – pro and against. Presentation a new technique improving quality of the image in the area of lateral recesus of vertebral canal

Address for correspondence:\ud Dimitar Stefanov Cholakov, MD\ud Department of Neurosurgery\ud University of Medicine – Plovdiv\ud 66 “Peshtersko shose” blv.\ud 4000 Plovdiv\ud Bulgaria\ud +359887869273\ud e-mail: dimcholakov@hotmail.bgThe causes of low back and leg pain should be sought thoroughly. They might be degenerative changes of the spine: disc prolapse, stenosis and their combinations. When the degenerative changes are in a phase of destabilization, the changes are in an early stage and can be discovered only during dynamic change of the position of the spine. In this study, our objectives are: to compare the data in the literature and to discuss the diagnostic value of the conventional myelography on the one hand, and of CT scan and MRI, on the other; to make lumbar myelography more tolerabl for the patients; to improve diagnostic abilities of the lumbar myelography to discover dynamic – position dependent, lumbar stenosis of the patients, especially in the cases where there is no image of compression in the CT scan or MRI. We studied two groups of 60 patients. In the first group, one neurorent-genologist did conventional myelography of the patients in sitting position. In the second group another neurorentgenologist performed myelography in the new way proposed by us. In that case, lumbar puncture was done of the patient in prone position on the x-ray table. After injection of the contrast medium, the position of the x-ray table was changed to vertical, and A-P, lateral, left and right oblique projections of x-ray images were taken. After that, x-ray table was moved back to horizontal position and x-ray images in A-P and both oblique projections were done. After the myelography, the patients in both groups were recom-mended to drink sufficient amount of fluid and to keep bed rest for 4 hours. We compared both groups of patients. It was found that when lumbar puncture was done in prone position less patients – 15 (25%) suffered from postdural puncture headache than those to whom dural puncture was performed in sitting position – 46 (77%). Conclusions: 1. Lumbar myelo-graphy is important method to obtain information about the condition of the lateral recessus, and helps to create preoperative plan in patients with position dependent lumbar stenosis. 2. The proposed by us method for performing myelography in prone position is better tolerated by patients and gives more information and better images of the lateral recessus. 3. It helps to plan the surgery in a way to prevent compromising outcome due to postoperative stenotic nerve root compression