The normal appearance of CT myelograms.

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CT myelography has been used since 1976 to diagnose neural compression in the axial skeleton. With the advent of routine MRI, its role in accurately diagnosing neural compression has been questioned as its normal appearances are not defined in the study. In this study, we examine a series of CT myelograms to define the normal appearances of the neural elements of the spine.


The CT myelograms of patients with unilateral symptoms were examined by four independent physicians. The lateral extent of contrast was examined and recorded. Concordance between the recorded extents was assessed using kappa scores.


Thirty-six scans were reviewed. Kappa analysis shows that there is a fair agreement in the lateral extent of contrast at L1, L3 and L4. At L2 and L5, agreement is slight.


The interpretation of CT myelography shows significant interobserver variability. As a result, the usefulness of this diagnostic tool can be questioned, and if misinterpreted, it could lead to questionable diagnoses and inadvertently erroneous management if used in isolation. These slides can be retrieved under Electronic Supplementary Material.





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Rocos, Brett, David RS Evans, Brathaban Rajayogeswaran and M John Hutchinson (2020). The normal appearance of CT myelograms. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 29(5). pp. 1087–1091. 10.1007/s00586-019-06287-5 Retrieved from

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Brett Rocos

Assistant Professor of Orthopaedic Surgery

I joined the team at Duke University Health from London, UK, where I was a Consultant Adult and Paediatric Spine Surgeon at Barts Health NHS Trust and Honorary Consultant Senior Lecturer at Queen Mary University of London. I completed my surgical training in in the South West of the UK and at the University of Toronto, and am fellowship trained in adult spine surgery, paediatric spine surgery, orthopaedic trauma surgery, research and healthcare management.

I am driven to support patients at every stage of their care, from clinic assessment, through surgery to discharge. Making sure that every person, adult, child, family or friend understands what’s wrong, helping them to choose the right treatment for them, and what the recovery will be like is an important priority.

My research activity focusses on finding effective new treatments for spinal disorders and bringing them to patients. Focusing on spinal deformity, I have led investigations in the UK, Canada and the USA, and I sit on the Global AO Knowledge Forum for Deformity and the Research Grants Committee at the Scoliosis Research Society. I have lectured in North America and Europe about the treatment of spine disorders for the Scoliosis Research Society, Global Spine Congress, AO Spine and Eurospine, and I have worked hard to produce research that improves the care for spine patients wherever they live. Lastly, I review for several orthopaedic journals and I am Deputy Editor of the Bone and Joint 360, a leading publication with a global readership.

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