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Spinal phlebography — Lumbar and cervical techniques
Journal of the Neurological Sciences, 1981:159-160
159
© Elsevier/North-Holland Biomedical Press
Book Reviews
Spinal Phlebography - - Lumbar and Cervical Techniques, by J. Th6ron and J. Moret, with a foreword by R. Djindjian, xi + 165 pages, 113 illustrations, 1 table, SpringerVerlag, Berlin, Heidelberg, New York, 1978, DM 118.00, US$ 64.90. The early development of spinal phlebography was stimulated by the need to find an alternative to myelography and, at the same time, a method capable of exploring at least part of the vascular system within the spinal canal. The intraosseous approach via a spinous process, pioneered by Fischgold, in France. and by Schobinger, in the United States, revealed a variety of applications related to both the vertebral venous plexus and the lumbo-azygos venous system. The proximity of the epidural veins to the nerve roots in the intervertebral discs in particular, leads to the early investigation of lumbar disc herniation. An anterior approach to the cervical vertebral bodies, advocated later by Greitz, permitted access to the cervical venous plexus. The authors of this monograph have, in conjunction with co-workers, developed techniques, described in 1976, for direct catheterisation of the venous plexuses, employing classical angiographic manoeuvres. They present here some of their experiences with disc herniations, tumours, anomalies and "neuralgia", in the lumbar and cervical regions. Much of the clinical recording is anecdotal. The only objective analyses are a correlation of lumbar venography in surgery in 100 patients, with disc herniation by J.P. Houtteville, and a report of 25 cervical venograms by Theron and others. Venography in the first series is regarded by the authors as a technique more sensitive to the detection of disc herniation than radiculography with Dimer X. Since the radiculography failed to provide sufficient information in almost half the cases reported, however, the quality of this procedure and its interpretation, must be questioned. The real advantages which venography of the spinal canal have provided in the reviewer's experience, have been the freedom from interference with the cerebrospinal fluid spaces and the ability to witness extradural neural compression outside the spinal canal in the intervertebral foramina. In recent years, of course, other major advances in spinal imaging have been introduced. Spinal arteriography and the development of a non-ionic water-soluble contrast medium, for both conventional and computed tomographic myelography, have added new dimensions with improved safety. These developments, combined with the disadvantages of spinal venography lack of specificity and the need with catheter methods for an experienced angiographic team, mean that the method has only found continued favour in a limited number of centres. Nevertheless, for the potential venographer, this monograph provides a useful guide, and source of reference despite occasional textual aberrations. It is intriguing to speculate on the fate of the "patient who vanished when lumbar puncture was attempted". The illustrative material is impeccable. lan Isherwood
Reflex Control of Posture and Movement (Progress in Brain Research, gol. 50), by R. Granit and O. Pompeiano (Eds.), xv + 827 pages, 338 illustrations, 6 tables, Elsevier/North-Holland Biomedical Press, Amsterdam, 1979, US$ 122.00, Dfl 250.00. Symposia provide an essential mechanism for the rapid dissemination of new findings and ideas, and their exposure to the wind of criticism. They also form a convenient forum for the review of growing subjects. In view of the usual pace of such a meeting most participants are glad of some permanent record of
159
© Elsevier/North-Holland Biomedical Press
Book Reviews
Spinal Phlebography - - Lumbar and Cervical Techniques, by J. Th6ron and J. Moret, with a foreword by R. Djindjian, xi + 165 pages, 113 illustrations, 1 table, SpringerVerlag, Berlin, Heidelberg, New York, 1978, DM 118.00, US$ 64.90. The early development of spinal phlebography was stimulated by the need to find an alternative to myelography and, at the same time, a method capable of exploring at least part of the vascular system within the spinal canal. The intraosseous approach via a spinous process, pioneered by Fischgold, in France. and by Schobinger, in the United States, revealed a variety of applications related to both the vertebral venous plexus and the lumbo-azygos venous system. The proximity of the epidural veins to the nerve roots in the intervertebral discs in particular, leads to the early investigation of lumbar disc herniation. An anterior approach to the cervical vertebral bodies, advocated later by Greitz, permitted access to the cervical venous plexus. The authors of this monograph have, in conjunction with co-workers, developed techniques, described in 1976, for direct catheterisation of the venous plexuses, employing classical angiographic manoeuvres. They present here some of their experiences with disc herniations, tumours, anomalies and "neuralgia", in the lumbar and cervical regions. Much of the clinical recording is anecdotal. The only objective analyses are a correlation of lumbar venography in surgery in 100 patients, with disc herniation by J.P. Houtteville, and a report of 25 cervical venograms by Theron and others. Venography in the first series is regarded by the authors as a technique more sensitive to the detection of disc herniation than radiculography with Dimer X. Since the radiculography failed to provide sufficient information in almost half the cases reported, however, the quality of this procedure and its interpretation, must be questioned. The real advantages which venography of the spinal canal have provided in the reviewer's experience, have been the freedom from interference with the cerebrospinal fluid spaces and the ability to witness extradural neural compression outside the spinal canal in the intervertebral foramina. In recent years, of course, other major advances in spinal imaging have been introduced. Spinal arteriography and the development of a non-ionic water-soluble contrast medium, for both conventional and computed tomographic myelography, have added new dimensions with improved safety. These developments, combined with the disadvantages of spinal venography lack of specificity and the need with catheter methods for an experienced angiographic team, mean that the method has only found continued favour in a limited number of centres. Nevertheless, for the potential venographer, this monograph provides a useful guide, and source of reference despite occasional textual aberrations. It is intriguing to speculate on the fate of the "patient who vanished when lumbar puncture was attempted". The illustrative material is impeccable. lan Isherwood
Reflex Control of Posture and Movement (Progress in Brain Research, gol. 50), by R. Granit and O. Pompeiano (Eds.), xv + 827 pages, 338 illustrations, 6 tables, Elsevier/North-Holland Biomedical Press, Amsterdam, 1979, US$ 122.00, Dfl 250.00. Symposia provide an essential mechanism for the rapid dissemination of new findings and ideas, and their exposure to the wind of criticism. They also form a convenient forum for the review of growing subjects. In view of the usual pace of such a meeting most participants are glad of some permanent record of