Spinal surgery following computerized tomography (CT) magnetic resonance imaging (MRI) and without myelography: 10 years experience

CT and MRI were substituted for myelography in the preoperative work up of 1000 patients who underwent spinal surgery over a 10 year period. The operative findings in 680 lumbar laminotomies for herniated nucleus pulposus, 120 laminectomies for narrow canal, spondylolisthesis, and neoplasm, and 200 anterior cervical discectomies were accurately predicted by and correlated with the 2 neuroradiologic studies. For over 10 years, a 2.0 Tesla superconductive MRI (Elscint) was available in Rockland County for neuroradiologic evaluation. Refinement in surface coil design, software, and scanning technique seem to have overcome the problems of providing thin, artifact-free sections with high signal to noise and contrast to noise in a short amount of time. The only cases who underwent conventional myelography or CT-myelography were extremely claustrophobic or had a contraindication to MRI such as an aneurysm clip or pacemaker. Patient preference for the noninvasive imaging, avoidance of lumbar puncture, and zero complication rate was virtually unanimous.