Pantopaque Myelography: Correlation of Roentgenologic and Neurologic Findings

Abstract

Contrast myelography has been practised for the past twenty-five years with various media and technics. Dandy (5) was the first to employ air for the purpose, and Coggeshall and von Storch (4) and Chamberlain and Young (3) were among the early and most enthusiastic advocates of air as a medium. Chamberlain and Young found that “in each case in which operation was performed, the exact level of the lesion determined by myelographic examination was verified by laminectomy.” Camp (1) also reported on the use of air. He stated that the positive findings were 90 per cent accurate, but 74 per cent of those operated upon after a negative myelographic examination proved actually to have lesions of the spinal canal. Hampton and Robinson (8) and Camp and Addington (2) are among the advocates of lipiodol for myelography, Hampton (7) claiming 93 per cent accuracy for that medium. Thorotrast has been employed by Nosik and Mortensen (10, 11). In a recent communication, Dandy (6) recommended establishing a diagnosis on the clinical and roentgenologic findings, without contrast material. The advantages and disadvantages of the various procedures have been well summarized by Pugh (12). The earliest use of pantopaque2 for myelography is credited to Garvey and Jones (15) of Strong Memorial Hospital, Rochester, N. Y., in 1940 and 1941, after extensive animal experimentation. The results of these early clinical trials were summarized by Warren before the Harvey Cushing Society in May 1942. Pantopaque for myelographic purposes was made available to the Armed Services in 1942 and has been used since then by the neurosurgical service of the National Naval Medical Center, Bethesda, Md. We were eager to employ this new contrast medium but agreed that it should be used only as an adjunct in the diagnosis and localization of lesions and that a negative myelographic report would not deter exploration if this were warranted on the basis of the clinical examination. For the purpose of this study we have analyzed 100 consecutive cases on the neurosurgical service with a provisional clinical diagnosis of protruded intervertebral disk. Pantopaque myelography was performed on nearly all patients with low back and sciatic pain in which this condition was suspected. It is considered by some neurosurgeons that a protruded disk produces signs and symptoms so diagnostic that myelography is unnecessary. The danger of this assumption is apparent since tumors of the cauda equina are not uncommon and, when small, may produce signs and symptoms indistinguishable from those due to disk protrusion. It is not within the scope of the present report to discuss in detail the clinical symptoms or the objective neurologic findings of the protruded intervertebral disk. The effect of trauma as an etiologic factor and the duration of symptoms are of interest, however, because we are dealing with naval personnel.