Lumbar epidural venography. Review of 1,200 cases

A review of 1,200 lumbar epidural venograms demonstrated venography to be accurate in 98.5% of 595 patients operated on for lumbar disc herniations. Venography is particularly valuable in two situations: first, in extreme lateral disc herniations, which frequently cannot be demonstrated by myelography, and second, if the caudal sac ends more cephalad than usual or tapers sharply, a centrally herniated L5-S1 disc can be missed by myelography. The examination is done on an outpatient basis, causes negligible discomfort, and is essentially free of complications. The authors feel that venography is the examination of choice in the investigation of suspected disc herniation. If there is clinical suspicion of an intradural lesion, myelography should be performed first.