[Myelography-still up to date?]

Myelography is used to visualize the spinal cord and its nerve roots either after intrathecal (IT) injection of contrast media into the spinal subarachnoid space (SAS) or noninvasively using heavily T2-weighted magnetic resonance (MRI) sequences. An IT injection can be image-guided (e.g., x‑ray fluoroscopy-guided or computed tomography (CT)-guided). Before the introduction of CT and MR imaging, fluoroscopic myelography was the predominant technique and the gold standard for neuroradiological examination of the contents of the spinal SAS. MR-myelography has not completely replaced fluoroscopic or CT-myelographic examination, and surgeons occasionally request supplemental myelography to resolve unclear MRI findings. Furthermore, the growing interest of neuroradiologists in accurately diagnosing and treating cerebrospinal fluid leaks has created a renewed need for this imaging modality. Spontaneous intracranial hypotension (SIH) is a cause of secondary headache resulting from the leakage of cerebrospinal fluid (CSF) from the spine. The typical presentation is an orthostatic headache that worsens in the upright position; however, over time, the orthostatic quality may be absent, and other headache types may occur. When conservative treatment or epidural blood patching are not effective, it may be necessary to localize the site of a spinal CSF leak to provide surgical treatment. Dynamic CT-myelography (CTM), digital subtraction-myelography (DSM), or dynamic fluoroscopic myelography are necessary to visualize the CSF leak.