Epidural venography was performed in 110 patients with suspected
lumbar-disc herniation by catheterization of the ascending lumbar and
ascending sacral veins. The findings by venography and by myelography were
compared with those revealed by operative exploration. Only sixty-one
patients had venography, myelography, and operative exploration. In fifty
of these patients with no previous disc surgery, the diagnostic accuracy of
venography was 98 per cent and of myelography, 90 per cent. Venography had
limited value in the other eleven patients who had had one or more prior
disc operations because it did not distinguish between scarring and
recurrent disc herniation at the levels previously explored. Selctive
ascending lumbosacral venography is indicated both in patients who have not
had a prior disc operation, as a guide to whether myelography should be
performed when the clinical picture is ambiguous, and in patients whose
myelogram is normal or equivocal but whose signs and symptoms are strongly
suggestive of disc herniation.