Role of weight-bearing flexion and extension myelography in evaluating theintervertebral disc

Magnetic resonance imaging has many advantages compared with myelography an d/or computed tomography in evaluating the lumbar spine for herniated nucle us pulposus. The authors have included a series of three patients whose his tories and physical examinations were clinically suggestive of herniated nu cleus pulposus but whose magnetic resonance imaging scans were interpreted by a radiologist as a disc bulge without nerve root compression. Because al l patients had not responded to a conservative care treatment program and s urgical intervention was to be considered, subsequent testing with lumbar m yelography with weight-bearing flexion and extension views demonstrated mor e clearly the presence of herniated nucleus pulposus along with compression of the nerve root; it also revealed that a positional change in the disc o ccurred with flexion and extension.