December 2017 Edition. Volume XVII

This page is from the text Neurosurgical Classics, Wilkins RH [Ed.], published by the Johnson Reprint Corp.: New York & London, 1965

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The fact that in 1965 Lipiodol (iodinized poppyseed oil) and its sister substance Pantopaque (iophendylate) were considered to be acceptable in the United States for myelographic purposes, according to Wilkins, is a sad fall-out related to the promise of safety made by Steinhausen and associates in 1944.

This is only one of a number of inaccurate observations made by Wilkins. All of the oil based myelographic agents: Lipiodol, Pantopaque, and Myodil were significantly toxic from both the neuropathologic as well as the clinical standpoints.  Lipiodol was first introduced by Sicard and Forestier in 1922 and “fell into disuse” in the United States in the 1930s due to reports of adverse effects on patients. Despite this information Lipiodol continued to be used in other countries. The last example of usage known to the Burton Report  is the case shown below from San Paulo, Brazil.  This Lipiodol myelogram was performed in 1963 on a then 26 year old patient with back pain who subsequently became disabled with clinically significant adhesive arachnoiditis.

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Although Lipiodol and Pantopaque were said, by the manufacturers to be absorbed at the rate of about 1 cubic centimeter/year it is clear that this was not so. The images shown above (1973 and 1998) show the persistence of encysted Lipiodol in the subarachnoid space over a period of 35 years following myelography.

J. Grafton Love, Chairman of the Section on Neurologic Surgery at the Mayo Clinic in Rochester, Minnesota first became aware of herniated lumbar discs from his contact with Mixter and Barr in 1934 during a American College of Surgeons meeting.  Dr. Love used Lipiodol for myelographic purposes.  He also performed a multi-level laminectomy and purposely opened the dural sac to remove the lipiodol at the time of surgery. Dr. Love’s surgical experience with “protruded disks” was presented on August 19, 1936 at a staff meeting of the Mayo Clinic.

His presentation on that night and his operative description have been preserved for posterity:

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Figure 2  shows the operative approach to remove the Lipiodol and associated inflammatory reaction.  A more vivid description of this inflammatory effect was provided 4 years later by fellow neurosurgeon Eric Oldberg, who provided a more descriptive observation of the neuropathologic insult to the subarachnoid space produced by the  Lipiodol.  It is difficult to comprehend, in the light of today’s non-invasive diagnostic studies, such as MRI, what havoc was created by leaving a toxic substance such as lipiodol in long-term contact with sensitive nervous system tissue.

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