Orthopaedic Tests and Procedures
What is a myelogram?
A myelogram, also known as myelography, is a diagnostic imaging procedure performed by a radiologist. It combines the use of a contrast substance with x-rays or computed tomography (CT) to evaluate abnormalities of the spinal canal, including the spinal cord, nerve roots, and other tissues.
The contrast "dye" is injected into the spinal column before the procedure. This substance, or dye, causes the tissue under study to be visible.
After the contrast dye is injected it appears on an x-ray screen allowing the radiologist to view the spinal cord, subarachnoid space, and other surrounding structures more clearly than with standard x-rays of the spine.
The radiologist may also use a CT scan when performing a myelogram. A CT or CAT scan is a diagnostic imaging procedure using a combination of x-rays and computer technology to produce cross-sectional images both horizontally and vertically across the body. These images, called slices, show detailed images of the spinal canal. CT scans provide more detail than standard x-rays.
Click Image to Enlarge
Anatomy of the spine:
The spinal column is made up of 33 vertebrae that are separated by spongy disks and classified into distinct areas.
- The cervical area consists of seven vertebrae in the neck.
- The thoracic area consists of 12 vertebrae in the chest area.
- The lumbar area consists of five vertebrae in the lower back area.
- The sacrum has five, small fused vertebrae.
- The four coccygeal vertebrae fuse to form one bone, called the coccyx or tailbone.
The spinal cord, a major part of the central nervous system, is located in the vertebral canal and reaches from the base of the skull to the upper part of the lower back. The bones of the spine and a sac containing cerebrospinal fluid surround it. The spinal cord carries sense and movement signals to and from the brain and controls many reflexes.
A myelogram may be performed to assess the spinal cord, subarachnoid space, or other structures for abnormalities, particularly when another type of examination, such as a standard x-ray, is inconclusive. Myelograms may be used to evaluate many diseases, including, but not limited to, the following:
- herniated discs
- spinal cord or brain tumors
- ankylosing spondylosis - a disease that affects the spine, causing the bones to grow together
- bone spurs
- arthritic discs
- cysts - benign capsules that may be filled with fluid or solid matter
- tearing away or injury of spinal nerve roots
- arachnoiditis - inflammation of a delicate membrane in the brain
There may be other reasons for your physician to recommend a myelogram.
You may want to ask your physician about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of x-rays, so that you can inform your physician. Risks associated with radiation exposure may be related to the cumulative number of x-ray examinations and/or treatments over a long period of time.
If you are pregnant or suspect that you may be pregnant, you should notify your physician. Radiation exposure to the fetus may cause birth defects.
Because a contrast dye is used during the procedure, there is risk of allergic reaction to the substance. Patients who are allergic to or sensitive to medications, contrast dyes, local anesthesia, iodine, shellfish, or latex should notify their physician. Also, patients with kidney failure or other kidney problems should notify their physician.
Because this procedure involves a lumbar puncture, the following potential complications may occur:
- A small amount of CSF can leak from the needle insertion site. This can cause headaches after the procedure. If there is a persistent leak the headache can be severe.
- There is a slight risk of infection because the needle breaks the skin's surface, providing a possible portal of entry for bacteria.
- A temporary numbness to the legs or lower back pain may be experienced.
- There is a risk of bleeding in the spinal canal.
- There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.
- Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
- You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
- Generally, fasting is required prior to administering contrast dye. Your physician will instruct you prior to the procedure of any necessary fasting requirements.
- Notify the radiologist if you have ever had a reaction to any contrast dye, or if you are allergic to iodine or seafood.
- Notify the radiologist if you are pregnant or suspect that you may be pregnant.
- Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking. You may be asked to stop some of your medications prior to the procedure.
- Sedation may be given prior to the procedure to help you relax.
- Notify the physician if you have a history of seizures or if you are taking any prescribed medications for seizures.
- Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
- If the procedure is performed on an outpatient basis, you may be asked to remain in the hospital for several hours following the procedure. You should plan to have another person drive you home.
- Based upon your medical condition, your physician may request other specific preparation.
A myelogram may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices.
Generally, a myelogram follows this process:
Click Image to Enlarge
- You will be asked to remove any clothing, jewelry or other objects that may interfere with the procedure.
- If you are asked to remove clothing, you will be given a gown to wear.
- You will be reminded to empty your bladder prior to the start of the procedure.
- During the administration of the contrast dye you may lie on the examination table in a side lying position with your chin tucked to your chest and knees tucked to your abdomen. Alternatively, you may sit on the edge of an examination table with your arms draped over a table positioned in front of you. In either position the back is arched, which helps to make space between the bones of the spine, or vertebrae.
- Your back will be cleansed with an antiseptic solution and draped with sterile towels.
- The radiologist will anesthetize the skin by injecting a local anesthetic that numbs the site. This injection may sting for a few seconds, but makes the procedure less painful.
- A needle will be inserted through the numbed skin and into the subarachnoid space where the spinal fluid is located. You will feel some pressure while the needle is inserted, but you must remain still during the insertion of the needle.
- The radiologist will remove some of the spinal fluid from the spinal canal. Next, a portion of contrast dye will be injected into the spinal canal through the needle. You may feel a warming sensation when the contrast dye is injected.
- When the contrast dye is administered, the needle will remain in place and you will be placed in the prone position (lying face down).
- The x-ray table will be tilted in various directions to allow gravity to move the contrast dye to different areas of your spinal cord. You will be held in place by a special brace or harness. More contrast dye may be administered during this process through the secured lumbar puncture needle.
- The required x-rays or CT scan pictures will be taken.
- When the test is completed, the needle will be removed and an adhesive bandage will be placed over the injection site.
- You should notify the radiologist if you feel any numbness, tingling, headache, or lightheadedness during the procedure.
You may experience discomfort during the myelogram. The radiologist will use all possible comfort measures and complete the procedure as quickly as possible to minimize any discomfort or pain.
You will require several hours of bed rest after the procedure. Your position may vary depending on the type of contrast dye that is used for the procedure.
You will be asked to drink additional fluids to rehydrate after the procedure. This helps to replace the spinal fluid that was withdrawn and reduces the chance of developing a headache.
A nurse will monitor your vital signs (blood pressure, temperature, pulse, and respirations) frequently after the test. Analgesic agents may be administered if you develop a headache.
When you have completed the recovery period, you will be taken to your hospital room or discharged to your home.
Once you are at home, notify your physician of any abnormalities, such as numbness and tingling of the legs, blood or other drainage from the injection site, pain at or near the injection site, inability to urinate, fever, stiff neck, or headaches. If the headaches persist for more than a few hours after the procedure, or when you change positions, you should contact your physician.
You may be instructed to limit your activity for 24 hours following the procedure. Generally, if no complications occur, you may return to your normal diet and activities.
Your physician may give you additional or alternative instructions after the procedure, depending on your particular situation.