Role of conventional lumbar myelography in the management of sciatica: An experience from Pakistan

OBJECTIVES: A prospective study of 80 patients suffering from sciatica was conducted at Fauji Foundation Hospital, Rawalpindi, Pakistan. The aim of this study was to select patients for lumbar myelography on clinical grounds in the absence of magnetic resonance imaging (MRI)/computerized tomography (CT) facilities and to know the causes of sciatica. MATERIALS AND METHODS: All patients underwent conventional lumbar myelography due to lack of MRI facility at a local hospital as well as financial constraints. Myelography was done with radio-opaque dye, Iopamidol, on outpatient basis RESULTS: Lumbar myelograms were positive in 77.5% and negative in 22.5% cases. Minor complications in the form of headache developed in 32.5% patients but no major complication like meningitis and archnoiditis developed. Lumbar disc prolapse and stenosis were found to be common causes of sciatica. Non-filling of nerve roots was seen in 33.87%, blocks (complete/partial) in 54.83%, and stenosis in 11.29% patients. CONCLUSIONS: Conventional myelography was found to be safe and an informative diagnostic technique in areas where facility of high-tech investigations like CT/MRI was not available. Conventional lumbar myelography could be recommended and performed with confidence on outdoor basis, in cases of sciatica with positive straight leg raising test, reflex loss, sensory, or motor deficit.