Vertebrospinal angiography in the evaluation of vertebral and spinal cord disease

Spinal angiography is an infrequently performed radiologic procedure requiring much skill and knowledge for its proper application. Most commonly, spinal angiography is used in the diagnosis of spinal arteriovenous malformations and in the delineation of vascular tumors of the spinal cord. Less usual indications may include preoperative evaluation of the spinal cord vasculature prior to surgeries involving the descending thoracic aorta or ventrolateral approaches to the spine, particularly in patients undergoing repeat operations. Spinal angiography should address three crucial considerations for the surgeon or neurointerventionalist: (1) the exact location and anatomic configuration of the lesion, (2) the vascularity of a lesion and identification of all feeding and draining vessels, and (3) depiction of the regional vascular anatomy of the spinal cord in relation to the lesion. Considering the relatively longer length of the procedure, larger contrast volumes, and increased complexity (as measured by catheter exchanges required) of spinal angiography, however, certain angiographic techniques (e.g., digital subtraction angiography, the use of general anesthesia, or placement of a groin sheath to facilitate catheter exchanges) and the use of low osmolality contrast agents should be considered to improve the quality of the examination while reducing risk.