Methods of transfemoral lumbar epidural venography in the diagnosis of lumbar disc herniation.

This article outlines several ways of achieving adequate visualization of the epidural venous plexus in the diagnosis of lumbar disc herniation. Preference is expressed for simultaneous injection of contrast medium via two catheters selecttively introduced into the lateral sacral segmental veins or into the left and right internal iliac veins. For visualization of the epidural veins, the investigator has a choice of over 20 different procedures. The position of choice of the catheter tip(s) can vary during the examination, dependent on diagnostic problems or technical catheterization problems. Epidural venography should be regarded as a very accurate, relatively simple method of demonstrating disc herniations in the lumbar region. This method is especially recommendable in cases that are clinically suspect but have a negative or dubious caudogram. The risk of complications is very small. It is also a good method for azygography. It is possible to perform the examination on outpatients.