Click the image for a larger version of the image in its own window. Image courtesy of Charles V. Burton, Institute for Low Back Care, Minneapolis, MN 19977

rare or a made-up disease. Unfortunately, there has been no in-depth research done in recent years to find the true incidence of the disease.

About 25% of the estimated 200,000-400,000 patients undergoing operations for lumbar disc disease in the United States each year are not improved or are made worse by surgery, so it is reasonable to calculate that, over the last 50 years in the United States, approximately 412,000 cases of clinically significant lumbosacral adhesive arachnoiditis have been produced. (4) In 1980, William H. Strain stated that “millions” of iophendylate myelograms had been performed since 1942, the year that he developed it. Even he stated that reactions from the use of his contrast agent were well known. He reported that arachnoiditis may exist in 10-15% of patients examined by myelography, and the sensitive arachnoid tissue is further irritated by the contrast agent (16)

Unfortunately, there has never been a formal investigation done in regard to the use of iophendylate in humans. The dye was introduced only in regard to the diagnosis of spinal tumors (delineation of the level of spinal block). How this agent came to be used for full-column myelography of discogenic disease is simply not to be found in the literature. (4)

Despite the fact that this oil based contrast was identified as being casually related to the production of arachnoiditis from the time of its introduction, its use in the United States has never been restricted by industry, government, or the medical profession. In Sweden and a number of other countries throughout the world (including the former Soviet Union), the situation has been quite different: on the basis of animal studies or clinical observation, iophendylate was removed from clinical practice in many countries as early as 1948.(4)

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