The radiological diagnosis of herniated lumbar intervertebral disk. A current controversy.

LUMBAR disk herniation was not fully recognized as a disease entity until 1934, when Mixter and Barr1published their now classic description. Only two years later, Hampton and Robinson2described the myelographic criteria for the diagnosis of this entity. For almost 50 years, myelography with radiopaque contrast media has been the diagnostic method of choice for detection and localization of herniated lumbar intervertebral disk.3-8The recent development of nonionic water-soluble iodinated contrast media with relatively low toxicity (eg, metrizamide)9,10has added a new dimension to the myelographic evaluation of disk herniation by allowing direct visualization of the compressed nerve root.6 Although the use of water-soluble contrast agents has now become widely accepted and has likely improved the diagnostic accuracy of the myelographic method,6Williams and colleagues have recently suggested that the diagnosis of herniated lumbar disk can be made in many cases by computed