Myelographic evaluation of cervical spondylosis: patient tolerance and complications.
METHODS
Retrospective chart review of documented adverse events in 637 consecutive patients after computed tomogram myelography and follow-up interview of the most recent 100 of these patients.


OBJECTIVE
This study assessed documented prevalence of adverse events after diagnostic myelography in cervical spondylotic patients and compared with perceived adverse events and satisfaction in a subset of the same cohort of patients.


BACKGROUND
There are some data that suggest complimentary benefits of myelography to magnetic resonance imaging. However, given the invasive nature of myelography, there are little data documenting the adverse events and patient experience with myelography to guide informed consent and physician choice of this study.


METHODS
We analyzed the records of 637 consecutive patients (364 males and 273 females) after myelography. Five hundred forty-four patients (group 1) had a cervical approach and 93 (group 2) had a lumbar approach. The last 100 consecutive patients (85 in group 1 and 15 in group 2) were asked questions that addressed patient perceived adverse reactions, pain levels, and satisfaction.


RESULTS
There was a 4.4% (28/637) prevalence of documented abnormal reactions. Group 1 had a 4.9% (25/506) prevalence of adverse reactions compared with 3.4% (3/89) in group 2. Overall 6.6% (42/637) had to have their myelographic procedures converted. Group 1 had 7% (38/544) converted to the lumbar approach group 2 had 4.3% (4/93) converted to the cervical approach. Thirty percent of the 100 patients interviewed felt they had an unexpected reaction (28 group 1 and 2 group 2). When interviewed, 14% of patients had maximum pain scores of 10 during the procedure and 8% (all group 1) felt worse pain after the procedure was completed. Six group 1 and 2 group 2 patients would not have the procedure again even when recommended by the surgeon. There was no statistically significant difference between complication rates, conversion rates, or patient perceived unexpected reactions between the 2 groups (beta=0.90).


CONCLUSIONS
This paper demonstrated the discrepancy between documented adverse events with computed tomogram myelography and patient reported tolerance as recorded by telephone follow-up. The cervical approach had a greater degree of patient perceived discomfort and a trend toward higher documented and patient reported adverse events and rate of approach conversion to a lumbar approach (P>0.5). When choosing myelography to evaluate patients with cervical spondylosis, the surgeon should consider the low patient tolerance and frequent adverse reactions that often go undocumented.
Chin
Kingsley R
KR
Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania and the University of Pennsylvania School of Medicine, PA 19104, USA. kingsleychin@hotmail.com
Eiszner
James R
JR
Huang
James L
JL
Huang
Jerry I
JI
Roh
Jeffrey S
JS
Bohlman
Henry H
HH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009192:Myelography / Q000009:adverse effects* / Q000706:statistics & numerical data; D017288:Pain Threshold / Q000523:psychology; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology*; D015995:Prevalence; D011843:Radiculopathy / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D013128:Spinal Osteophytosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed / Q000009:adverse effects* / Q000706:statistics & numerical data