Hopkins Study Clears Spinal X-Ray of Wrongdoing

Johns Hopkins researchers reviewing a decade of patient records of those who underwent spinal angiography found the procedure to be safe and effective, they reported online this week in the journal Neurology.

The procedure, an X-ray of the blood vessels near the spinal cord, has been feared to trigger possible complications of stroke and kidney damage. The researchers found that none of the 302 patients who underwent a spinal digital subtraction angiography, or SpDSA, at the Johns Hopkins Hospital between 2000 and 2010 had suffered either a stroke or kidney damage as a result of the procedure.

SpDSA helps distinguish among many types of vascular disorders near the spine. These include strokes, hematomas, aneurysms, fistulas, and tumors.

“Patients and their physicians can now look with confidence to our study and see for themselves the real as opposed to perceived risks and complications from spinal angiography,” said study senior investigator and interventional neuroradiologist Philippe Gailloud, MD, adding that “neurologists and patients really should consider this valuable diagnostic tool based on the actual medical evidence and not on whatever unsubstantiated rumors they might hear secondhand or read on the Internet.”

Gailloud said reports of stroke and kidney damage had been rather high, in as many as 3 percent of people, in the 1970s when the procedure was first introduced. Then, preparing patients for testing and injecting a dye to make the blood vessels more visible often took hours instead of the 30 minutes it takes today, raising the chances that a clot could dislodge in the blood vessels and cause a stroke. The earlier process also used up more than twice as much of the potentially toxic contrast agent than is needed today.

Another key finding in the study was that spinal angiography could rule out suspected cases of transverse myelitis, a type of spinal inflammation. Fourteen of 45 patients diagnosed and treated with steroids or other immune-suppressing drugs for transverse myelitis were later confirmed by SpDSA to have a vascular malformation instead. All of these patients were successfully treated for their actual spinal problem, and none of them suffered complications as a result, the researchers reported.