Outpatient Myelography: A Prospective Trial Comparing Complications after Myelography between Outpatients and Inpatients in Japan

다국어 초록 (Multilingual Abstract)

Study Design: Prospective comparative study.
Purpose: To compare the incidence and severity of adverse reactions associated with myelography performed in outpatients vs. in inpatients and report the safety and usefulness of outpatient myelography in Japanese patients.
Overview of Literature: Myelography is normally performed as an inpatient procedure in most hospitals in Japan. No studies have reported the usefulness and adverse effects of outpatient myelography in Japanese patients.
Methods: We performed 221 myelography procedures. Eighty-five of the 221 patients underwent outpatient myelography using our new protocol. The incidence and severity of adverse reactions were compared with the other 136 patients, who underwent conventional inpatient myelography. We further compared the cost of outpatient and inpatient myelography.
Results: The overall rate of adverse effects was 9.4% in outpatients, as compared with 7.4% in inpatients. Overall, 1.2% of outpatients and 0.74% inpatients experienced “severe” adverse effects (requiring hospitalization). There were no significant differences between the 2 groups in either the overall rate of adverse effects or the rate of “severe” adverse effects. Moreover, the average outpatient procedure cost was only one-third to one-half that of the inpatient procedure.
Conclusions: This was the first study to address the safety and usefulness of outpatient myelography in Japanese patients. If selected according to proper inclusion criteria for outpatient procedure, no significant differences were observed in the adverse effects between inpatients and outpatients. The outpatient procedure is more economical and has the added benefit of being more convenient and time-efficient for the patient.

참고문헌 (Reference)

1 Hafer J, "The effect of needle type and immobilization on postspinal headache" 46 : 860-866, 1997

2 Pascual LF, "Spontaneous intracranial hypotension: quick clinical and magnetic resonance imaging response to corticosteroids: A case report" 42 : 359-361, 2002

3 Hong M, "Spontaneous intracranial hypotension causing reversible frontotemporal dementia" 58 : 1285-1287, 2002

4 Thorstensen O, "Side effects after lumbal myelography: a prospective study of outpatients" 87 : 293-296, 2001

5 Olsen J, "Seizures after myelography with lopamidol" 12 : 329-330, 1994

6 Halpern S, "Postdural puncture headache and spinal needle design: metaanalyses" 81 : 1376-1383, 1994

7 Kuntz KM, "Post-lumbar puncture headaches: experience in 501 consecutive procedures" 42 : 1884-1887, 1992

8 Flaatten H, "Post-dural puncture related complications after diagnostic lumbar puncture, myelography and spinal anaesthesia" 98 : 445-451, 1998

9 Junck L, "Neurotoxicity of radiological contrast agents" 13 : 469-484, 1983

10 Norris MC, "Needle bevel direction and headache after inadvertent dural puncture" 70 : 729-731, 1989

11 Pensbo T, "Myelography, can it be performed as an outpatient procedure?" 164 : 2757-2760, 2002

12 Bassi P, "Myelography with iopamidol, a nonionic water-soluble contrast medium: incidence of complications" 24 : 85-90, 1982

13 Dieterich M, "Is obligatory bed rest after lumbar puncture obsolete?" 235 : 71-75, 1985

14 Spriggs DA, "Is bed rest useful after diagnostic lumbar puncture?" 68 : 581-583, 1992

15 Meador K, "Irreversible neurologic complications of metrizamide myelography" 34 : 817-821, 1984

16 Strupp M, "Incidence of postlumbar puncture syndrome reduced by reinserting the stylet: a randomized prospective study of 600 patients" 245 : 589-592, 1998

17 Dieterich M, "Incidence of post-lumbar puncture headache is independent of daily fluid intake" 237 : 194-196, 1988

18 Lybecker H, "Incidence and prediction of postdural puncture headache: a prospective study of 1021 spinal anesthesias" 70 : 389-394, 1990

19 Solomon GD, "Hypersensitivity to substance P in the etiology of postlumbar puncture headache" 35 : 25-28, 1995

20 Aasly J, "Experiences with ambulatory radiculography" 109 : 951-952, 1989

21 Centeno RS, "Brain changes on computed tomography following metrizamide myelography. Significance and therapeutic implications" 11 : 509-512, 1986

22 Cook PT, "Bed rest and postlumbar puncture headache: the effectiveness of 24 hours’ recumbency in reducing the incidence of postlumbar puncture headache" 44 : 389-391, 1989

23 Evans RW, "Assessment: prevention of post-lumbar puncture headaches: report of the therapeutics and technology assessment subcommittee of the american academy of neurology" 55 : 909-914, 2000

24 Sobel DF, "Adverse reactions to iopamidol and iohexol myelography with special attention to headache: role of myelographic technique" 29 : 519-522, 1989

25 Tourtellotte WW, "A randomized, double-blind clinical trial comparing the 22 versus 26 gauge needle in the production of the post-lumbar puncture syndrome in normal individuals" 12 : 73-78, 1972

26 Drayer BP, "A doubleblind clinical trial of iopamidol versus metrizamide for lumbosacral myelography" 58 : 531-537, 1983