Complete myelography with metrizamide.

Thorough myelography of the entire spinal cord including the foramen magnum region can be accomplished consistently and promptly after metrizamide injection via lumbar or lateral cervical puncture. When lumbar puncture is used the patient's torso is oblique, but the neck is prone and straight and the table is tilted 20 degrees head-down to allow direct cervical filling with contrast material. Each region is filmed in several projections, the patient being turned gently from the prone cervical to the supine thoracic position. Of 100 cases without block studied in this way, all had adequate cervical and foramen magnum films. In only five was the contrast material too dilute to show the edges of the spinal cord well and the subarachnoid sac adequately in the thoracic region. In 29 patients, there were mild side effects not requiring medication, while 20 had side effects of a more moderate to severe nature. No seizures were encountered. Metrizamide proved a convenient, efficient, and acceptable contrast medium for myelography when a study of the entire spinal cord is indicated.