[Epidural systematic double-catheter venography in the diagnosis of lumbar disc herniation; mysterious vein in the vertebral canal (author's transl)]

Abstract

Epidural venography should be regarded as a very accurate, relatively simple method of demonstrating disc herniations in the lumbar region. This procedure is especially recommendable in cases that are clinically suspect but have a negative or dubious myelogram. Systematic double-catheter venography has to be considered as an important addition to the existing diagnostic procedures for lumbar disc disease, especially when the more conventional methods have failed. This method should be considered at least as reliable as myelography, and even more reliable in the diagnosis of lateral disc herniations. However, small midline herniations may be missed. In some cases it is possible to detect a trapped root, not caused by a disc herniation. In our experience in 120 cases, systematic use of 2 catheters and simultaneous injection of contrast provides excellent, homogenous visualisation of the epidural venous plexus and surrounding veins. The reliability of the X-rays is definitely superior to the single catheter method. The Seldinger technique is used; the approach is via the right and left femoral vein. The cathetertips are selectively introduced from both sides either into a lateral sacral vein, an internal iliac vein or into a lumbar ascending vein. This can be performed as well on the homolateral or on the heterolateral side. This results in six possibilities from each groin, providing a fairly large number of procedures to obtain adequate filling of the epidural and surrounding veins. The position of choice of the cathetertip(s) can vary during the examination, dependent on diagnostic problems or technical catheterisation problems. The risk of complications is very small. It is possible to perform the examination on outpatients. The adequate demonstration of the epidural veins enables us to visualise frequently a small straight vein in the midline of the vertebral canal, that is unknown in the anatomical literature until now.