Evaluation of cervical spinal cord injuries with metrizamide myelography-CT scanning

In the past, patients with injuries of the cervical spine and spinal cord have been diagnosed by means of myelography and polytomography. In an attempt to improve the radiographic evaluation of patients with cervical spinal cord injuries the authors performed computerized tomography (CT) scanning of the cervical spine following injection of metrizamide into the spinal subarachnoid space. In 23 patients with cervical spinal cord injuries, metrizamide myelography was performed via a C1-2 puncture. Myelography was used only for localization of the lesion and to determine the site of CT scanning. After myelography, CT scanning of the cervical spine in the transaxial plane was effective in determining the exact nature of compressive lesions and distinguishing the etiology among hematoma, disc, bone fragments, osteophytes, or ossification of the posterior longitudinal ligament. In several patients, metrizamide could be seen entering the spinal cord and was indicative of anatomical spinal cord disruption. In patients with fractures, CT scanning identified the site and nature of the injury without the need for turning the patient to the lateral position. In several patients with an apparently stable cervical spine, the CT scan showed apophyseal joint widening indicative of instability. The authors conclude that CT scanning of the cervical spine after the introduction of metrizamide into the subarachnoid space provides a definitive evaluation of the cervical spinal cord, the bone structures of the cervical spine, and their relationship to each other.