Resurgence of the Role of Computed-Tomography Myelogram in the Era of MRI for Surgical Decision-Making of Lumbar Degenerative Disc Disorder

Keyur Kantilal Akbari; Vigneshwara Badikillaya; Muralidharan Venkatesan; Rochita V. Ramanan; Sajan K. Hegde

doi:10.14444/8101

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Figure 1
A 60-year-old gentleman presented with low back pain radiating to left lower limb with claudication distance of 100 m for 3 months. (A) Sagittal MRI showing multilevel disc protrusion with predominant compression at L4-L5 and L5-S1 levels. (B) Sagittal computed tomography myelography (CTM) and (C) axial CTM showing left paracentral disc bulge at the L4-L5 level with no other significant compression. (D) Intraoperative image of transforaminal lumbar interbody fusion with left-sided unilateral exposure at the L4-L5 level with disc fragment marked by arrow. Cr, cranial; Cd, caudal; L, lateral; M, medial. At follow-up after 3 months patient had no leg pain and had improved visual analog scale (VAS) scores for back and leg pain as well as improved Oswestry Disability Index (ODI) scores.
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Figure 2
Root impingement. A 63-year-old gentleman presented with low back pain radiating to the left lower limb with a claudication time of 5 minutes for 6 months. MRI did not show any significant compression. Computed tomography myelography (CTM) showed left paracentral disc compressing the traversing nerve root at the L4-L5 level. Transforaminal lumbar interbody fusion (TLIF) L4-L5 was done, and at 6 months follow-up the patient had no radicular symptoms.
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Figure 3
A 66-year-old lady with multiple comorbidities presented with low back pain radiating to both lower limbs (left more than right) with a claudication time of less than 5 minutes. MRI showed compression at multiple levels. Computed tomography myelography (CTM) curved sagittal reconstruction corrected for mild scoliosis and showed major compression at the L3-L4 level. Patient underwent transforaminal lumbar interbody fusion (TLIF) at the L3-L4 level, and at 6 months follow-up she had improved visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. In such cases, multilevel decompression would have added increased surgical morbidity in a frail patient.
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Figure 4
A 70-year-old woman presented with low back pain radiating to the left anterior aspect of the thigh and lateral aspect of the left leg with a claudication distance less than 500 m for the past 1 year. MRI showed multilevel compression. Computed tomography myelography (CTM) with curved sagittal reconstruction clearly showed canal stenosis at L2-L3 and a left paracentral compression at the L3-L4 levels. The patient underwent transforaminal lumbar interbody fusion (TLIF) at the L2-L3 and L3-L4 levels. At 6 months follow-up, she had no radicular pain and improved visual analog scale (VAS) and Oswestry Disability Index (ODI) scores.