Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXXIII: Wounds and Injuries of the Spinal Column and Cord

Myelography

United States Department of Defense
Peer Review Status: Internally Peer Reviewed

The use of metrizamide myelography is indicated in the following situations:

1. Patients with incomplete injuries who demonstrate neurologic deterioration upon serial reassessment.
2. Patients with an incomplete neurological injury who require surgery for spine stabilization or other procedures.
3. Patients with incomplete injuries who fail to improve following closed reduction.
4. Patients with progressive neurological improvement followed by the sudden appearance of a neurological plateau.
5. Patients with neurological injury without evidence of vertebral column injury.

Myelography is not advisable in neurologically complete injuries. If performed, and found abnormal in the patient with absent neurological function below the level of injury, a tendency exists for the obstruction to be surgically "relieved." Neurological improvement seldom follows operation and may contribute to mechanical instability of the spine. Thus, knowledge of an obstruction to the flow of contrast material serves no beneficial function.

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