A new relative contraindication for lumbar myelography

Area of Science:

• Neurosurgery
• Radiology
• Orthopedic Surgery

Background:

• Post-tuberculous thoracic gibbus and severe thoracic cage deformities present complex clinical challenges.
• These deformities can impact respiratory function and overall patient physiology.
• Previous literature has not extensively detailed the risks of myelography in such cases.

Purpose of the Study:

• To evaluate the safety and potential complications of lumbar myelography in patients with severe thoracic deformities.
• To investigate the association between thoracic cage deformity and adverse events during myelography.
• To determine if specific contrast agents pose a higher risk in this patient population.

Main Methods:

• Myelography was performed on six patients with significant post-tuberculous thoracic gibbus and thoracic cage deformity.
• Two patients underwent myelography using water-soluble contrast media: Conray Meglumine and Dimer X.
• Clinical outcomes, including neurological events, were closely monitored.

Main Results:

• Two patients experienced severe adverse events, including violent convulsions and femoral neck fracture.
• The use of water-soluble contrast media (Conray Meglumine, Dimer X) was noted in these cases.
• A correlation between severe thoracic deformity and the occurrence of convulsions was observed.

Conclusions:

• Severe thoracic cage deformity should be considered a relative contraindication for lumbar myelography using water-soluble contrast media.
• Reduced tissue oxygenation, common in patients with significant thoracic deformities, may lower the threshold for convulsions.
• Further research is warranted to establish definitive guidelines for myelography in patients with spinal deformities.