J Korean Soc Spine Surg.  2020 Jun;27(2):55-61. 10.4184/jkss.2020.27.2.55.

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

• Song WS
• Lee YS
• Lee J
• Kim J

• KMID: 2503672
• DOI: http://doi.org/10.4184/jkss.2020.27.2.55

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.

Keyword

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