Spinal Phlebography ─ Lumbar and Cervical Techniques

Spinal phlebography is an "indirect" radiologic technique for investigating verte- bromedullary pathology. It is a harmless and almost painless technique that does not require the introduction of contrast medium into the subarachnoid spaces. Its interpretation is based on the modifications of the epidural veins which do not themselves have any proven pathology. The longitudinal epidural veins are situated in the anterolateral angles of the spinal canal between the nerve root and the intervertebral disc. They conse- quently represent a major anatomic landmark in the investigation of disc pathol- ogy because they are compressed by a disc herniation before the corresponding nerve root is reached. The improvement of the techniques of lumbar phlebography by catheterization of the lateral sacral veins and of cervical phlebography by catheterization of the vertebral veins now permits opacification of the epidural venous system along the total length of the lumbar and cervical spine. Spinal phlebography can consequently be used routinely, primarily in disc pathology but now also in other fields of vertebromedullary pathology such as myelopathy, tumors, or stenosis of the spinal canal, where it provides new information as compared to the other techniques of investigation. The techniq ue and results of spinal phlebography in these various conditions are presented in this monograph which is an attempt, with the collaboration of several authors, to summarize current knowledge in this field. Only lumbar and cervical phlebography will be discussed in this monograph.