[Total myelography with metrizamide through the lumbar route (author's transl)]

Total myelography with metrizamide at a concentration of 270 mgI/ml was carried out via lumbar puncture in 170 consecutive patients. Good opacification and/or diagnostic value was obtained in the lumbar, thoracic and cervical region at 88.8%, 77.6% and 72.4% respectively. Unsatisfactory results were mostly due to the poor technique of physicians and x-ray technicians. Also it was inadequate to perform this study in some lesions, such as ruptured arterio-venous malformation and occification of posterior longitudinal ligament. Several cases with previous oil myelography showed poor results, because the remaining of Myodil disturbed a good spreading of the newly injected media. It was requested to evacuate oily contrast media prior to metrizamide myelography. One of the most important clues to a successful myleography was to make dilusion of contrast media as little as possible, and the use of high concentration of metrizamide (250-270 mgI/ml) seemed to be tolerated. It was also important to avoid excessive movement of the patient and the rapid transit of the contrast media to the level of interest. It was recommended to study the entire spinal subarachnoid space as a whole. In sixty-three patients out of 170, one or more abnormal myelographical findings were detected at unexpected level. Immediately after the examination the patients were encouraged to drink a large quantity of diuretic beverages such as tee, juice or coffee for the purpose of reducing side effects. As Potts and coworkers and Eldevik and associates reported, it was recognized that the overhydration could reduce the severe side effects after the metrizamide myelography.