What are the main disadvantages of using myelography as an isolated test to assess spinal disorders

• Myelography is an invasive test.

• Complications and unpleasant side effects may occur (e.g. adverse reaction to contrast, spinal fluid leak, spinal headache).

• Myelography is less accurate than CT or MRI in evaluating disc pathology.

• Myelography cannot detect pathology below the level of a complete block to contrast.

• Myelography provides only indirect evidence of neural compression by demonstrating changes in contour of contrast-filled neural structures.

• Myelography cannot differentiate whether extradural compression is due to disc, osteophyte, tumor, or infection.

• Myelography cannot visualize pathology in the lateral zone of the spinal canal because the contrast-filled dural sac ends in the region of the pedicle.

• Pathology may be missed at the L5-S1 level, where the spinal canal is very wide, and a large disc protrusion or osteophyte may not deform the dye column.

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