Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2020 Jun;27(2):55-61. Korean.
    Published online Jun 30, 2020.
    https://doi.org/10.4184/jkss.2020.27.2.55
    © Copyright 2020 Korean Society of Spine Surgery
    Original Article

    Functional Myelography as a Diagnostic Tool in Patients with a Mismatch between Symptoms and MRI Findings

    Woo-Suk Song, M.D., Young-Sang Lee, M.D., Joonha Lee, M.D. and Jin Kim, M.D.
      • Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Seongnam, Korea.
    • Corresponding author: Young-Sang Lee, M.D. Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, 20, Seohyeon-ro 180beon-gil, Bundang-gu, Seongnam, 13590, Korea. TEL: +82-31-779-0175, FAX: +82-31-779-0176, Email: ceacles@dmc.or.kr
    Received March 16, 2020; Revised March 20, 2020; Accepted April 16, 2020.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Study Design

    Retrospective comparative study.

    Objectives

    The aim of this study was to analyze the usefulness of functional myelography in patients with a mismatch between symptoms and magnetic resonance imaging (MRI) findings.

    Summary of Literature Review

    Functional myelography was a widely-used diagnostic tool decades ago, although it has been considered to be an old-fashioned technique since MRI was invented. Despite its invasiveness, functional myelography can be a useful method, with advantages in axial loading situations in symptomatic patients and its dynamic element at the point of imaging.

    Materials and Methods

    From May 2017 to December 2018, 141 patients who underwent MRI, functional myelography, and surgical treatment were included, and the MRI and functional myelography results were compared. The independent-samples t-test and chi-square test were used to compare parameters, surgical results, and diagnoses using both methods between the matched and mismatched groups. The Fisher exact test was used for post hoc testing.

    Results

    Ten patients (7.1%) had different diagnoses based on MRI and functional myelography. All of these patients' symptoms matched the functional myelography results, and the patients had non-significantly different visual analogue scale scores for pain in both groups. The diagnoses made by MRI showed statistically significant differences, all of which were negative, in the mismatched group, but the patients did not show a significant difference when diagnosed by functional myelography. We performed surgical treatment according to the functional myelography results, and the patients' symptoms were relieved, without a statistically significant difference.

    Conclusions

    In patients with a mismatch between symptoms and MRI findings, functional myelography can be a useful additional diagnostic tool.

    Keywords
    Functional myelography; Spinal stenosis; Herniated intervertebral disc; Diagnosis; Mismatch

    Figures

    Fig. 1
    A 60-year-old woman was diagnosed with foraminal stenosis at L4-5 on the right side without central stenosis by magetic resonance imaging (A, B, C), but a filling defect at the same level and further slippage were shown in functional myelography (D).

    Fig. 2
    A 69-year-old woman was not specifically diagnosed beyond bulging discs on magnetic resonance imaging (A, B, C), but a filling defect at L4-5 was shown by functional myelography (D).

    Fig. 3
    A 71-year-old woman was diagnosed with Kummel's disease at L1 without canal encroachment (A, B, C), but a filling defect was shown on functional myelography (D).

    Tables

    Table 1
    Demographic features of patients (persons, %/average, ±SD, * : statistically significant, HIVD: herniated intervertebral disc)

    Table 2
    Summary of Mismatched Patients (Deg. spondylolisthesis : degenerative spondylolisthesis, NIC : neurogenic intermittent claudication, L/E : lower extremity)

    Table 3
    Radiologic and Clinical Results (persons, % / average, ± SD, * : statistically significant)

    Table 4
    Complications of Patients after Functional Myelography (persons, %)

    References

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    MeSH Terms
    Diagnosis
    Elements
    Humans
    Magnetic Resonance Imaging*
    Methods
    Myelography*
    Retrospective Studies
    Spinal Stenosis
    Weight-Bearing
    Metrics
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