Venographic findings on the changes of the lumbar anterior internal vertebral vein in regard to age

Abstract

Since 1972, we have been performing transvenous epidural venography in our clinic as an auxiliary diagnostic procedure for lumbar disc herniation.
However, many “false-positive”findings were obtained when trying to apply this method to middle-aged and older patients. It should be noted first tha epidual venography was principally performed on patients with lumbar disc herniation. Thus, most venographic results were obtained for patients in their 20 s and 30 s.
During the period from 1974 until 1978, we studied epidural venogram in patients with various cases of low back pain and different ages ranging from young to old. We carried out epidural venogram on 74 patients (61 males, 13 females, aged from 5 to 65 years) suffering from various types of lumbar complications to establish the incidence of false-positive findings in regard to age.
In addition, optical pathological and morphological examinations were performed on the anterior internal vertebral vein of the L 5 spinal body level excised from fresh corpses of 36 cadavers (22 males, 14 females, with ages ranging from 0 to 85).
The results were as follows :
1) The false-positive findings included deficient venograms as well as venograms with a meandering, irregularly bent and narrowed-down pattern. Of these, the clinically most problematic ones were the deficient findings. For the age group of 0-20 years of age, no deficient findings were observed, but there was a tendency for these to increase very sharply with age, totalling 41% for patients in their 40s and 50% for patients in their 50s and 60s.
2) In terms of the contrast range, it was found that the younger the patients were, the greater the tendency for the contrast range to extend up to the superior lumbar vertebrae.
3) No spider's-web-like shadow was observed in patients up to 30 years old, whereas this pattern appeared at a 50% incidence in patients aged from 61.
4) The incidence of growth in the collagen fiber material in the media of the anterior internal vertebral vein was found to be 67% for light cases aged up to 20 years, but 8196 for medium cases aged more than 61.
5) The cross-sectional appearance of the anterior internal vertebral veins was divided into four types on morphological grounds. Among the young patients, the normal type occurred very frequently. Among the middle-aged cases, collagen fibrosis in the media of the vein or partial fibrosis and partial thinning tended to be the predominant types. In the older group, total circumferential thinning occurred at high incidence.
From the above results, it is clear that, with progressing age, the incidence of false-positivefindings increases proportionally. This is attributed to the changes of the anterior internal vertebral vein with aging, i. e., to the venosclerotic processes associated with aging.
Therefore, in diagnosing patients older than 40, it is necessary to exercise much more care in evaluating their venograms by taking the aging processes affecting the veins into account.