Gross deformity of the spine; a lumbar myelographic risk with Conray and Dimer X

Iohexol and metrizamide in lumbar myelography. Comparison of side effects

In routine lumbar myelography carried out in 100 patients iohexol (n = 50) produced side effects in fewer patients (p less than 0.03), especially meningeal and cerebral (p less than 0.03), and among these a lower rate of headache (p less than 0.07), than did metrizamide. The overall frequency of afflicted patients (50% after iohexol and 72% after metrizamide) was high, mainly because of deliberate inclusion of patients with a high risk of side effects in the investigation. The side effects recorded up to six hours after the administration of the contrast medium were less frequent when using iohexol. If severe side effects are present at 24 hours or appear thereafter, as occurred in a few of the present patients after iohexol, surgical treatment or discharge of the patient is in some cases unnecessarily delayed.

A new relative contraindication for lumbar myelography

We have taken myelograms of six patients with grave post-tuberculous thoracic gibbus of the spine and gross deformity of the thoracic cage. Two of these patients suffered violent convulsions and fracture of the neck of the femur. In one patient the myelogram was taken with Conray Meglumine and in another with Dimer X. We suggest that a grave deformity of the thoracic cage is a relative contraindication for lumbar myelography with these water-soluble contrast media. We assume that the reduced tissue oxygenation in these patients results in a lower threshold for convulsions.