Influence of Myelography and Postmyelographic CT on Therapeutic Decisions in Degenerative Diseases of the Cervical Spine

Study Design: A retrospective analysis of clinical records and radiologic imaging by 3 independent reviewers to assess the indication for surgical treatment with and without myelography and postmyelographic computed tomography (MCT). Objective: To evaluate whether myelography and MCT obtained in addition to magnetic resonance imaging (MRI) influence therapeutic decisions in degenerative diseases of the cervical spine. Summary of Background Data: MRI has become the standard examination in spinal diseases. The role of myelography and MCT is not clearly defined in the modern diagnostic setup. In many departments, they are used if MRI leaves some diagnostic uncertainty. It has not been examined yet whether additional myelography and MCT change therapeutic strategies. Materials and Methods: Three investigators independently reviewed the anonymized clinical data and image files of 105 patients who had all undergone MRI, myelography, and MCT. They determined their treatment decisions after each of 2 assessment rounds based on the following: (1) MRI and, if available, native CT, and plain radiographs. (2) Additional myelography and MCT. The intraobserver variability was the primary endpoint. Results: Myelography and MCT had been performed in multilevel disease, recurrent complaints after surgery, or if MRI had not revealed a clear finding. The intraobserver variability was 26.3% and varied markedly between the 3 investigators (17%41 %). It was the highest in cases of multilevel disease. If noninvasive imaging included native CT and plain radiographs, the intraobserver variability was significantly reduced to 10.3%. Conclusions: In unclear cases of degenerative disorders of the cervical spine, particularly multilevel stenosis, myelography and MCT add relevant information for therapeutic decisions in more than a quarter of the patients in comparison with MRI as the sole diagnostic modality, and changes therapeutic strategies. However, a significant part of the information drawn out of myelography and MCT can be obtained by a completion of noninvasive examinations (native CT and radiographs).