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Myelography (Myelogram)

Myelography is an imaging examination that involves the introduction of a spinal needle into the spinal canal and the injection of contrast material in the space around the spinal cord and nerve roots (the subarachnoid space) using a real-time form of x-ray called fluoroscopy.

When the contrast material is injected into the subarachnoid space, the radiologist is able to view and evaluate the status of the spinal cord, the nerve roots and the meninges. The meninges are the membranes which surround and cover the spinal cord and nerve roots. Myelography provides a very detailed picture (myelogram) of the spinal cord, nerve roots, subarachnoid space and spinal column. The radiologist views the passage of contrast material in real-time within the subarachnoid space as it is flowing using fluoroscopy but also takes permanent images, called x-rays or radiographs, of the contrast material around the spinal cord and nerve roots in order to document abnormalities involving or affecting these structures. In many of these cases, the myelogram may be followed by a computed tomography (CT) scan to better define the anatomy and any abnormalities.

What to Bring

  • Your physician order
  • Personal identification
  • Insurance card(s)
  • Medication list

How to Prepare for Your Myelogram Exam

  • Ask your physician for specific guidelines about discontinuing alcohol use, aspirin products, and blood-thinning medications before the procedure.

**Some drugs should be stopped one or two days before myelography. These include certain antipsychotic medications, antidepressants, blood thinners, and some other drugs. The most important type of medication that must be stopped is blood thinners (anticoagulants). If you are taking blood thinners, you should speak with your physician about alternative methods of maintaining anticoagulation while you are undergoing a myelogram.

  • Make a list of any allergies you may have, especially to Iodine, Betadine, Novocaine or Latex.Allergic reactions to the contrast dye are rare, but can occur. Be sure to tell your physician if you have ever had an adverse reaction to any of the above. There are some alternate contrast materials that can sometimes be used in these cases, as well as other testing options.
  • Maintain your regular eating schedule. There are no dietary or fluid restrictions before the test.
  • If there is any possibility that you are pregnant, you should always inform your x-ray technologist.
  • If you have an on-body device (insulin pumps, insulin regulators, Neulasta, other chemo pumps, etc), you must inform your Radiologic Technologist. These devices cannot be in the x-ray room during your exam.
  • Leave all valuables at home.
  • You will be given a gown to wear during the procedure. You may be asked to remove jewelry, glasses and any metal objects or clothing that might interfere with the x-ray images.
  • Please make arrangements for transportation, as you will not be allowed to drive immediately after the test.
  • Drink 2 1/2 quarts of liquid the day of the myelogram and the day after. This could help with eliminating a headache after the procedure.

What to Expect

  • This examination is usually done on an outpatient basis.
  • A Radiology Nurse will call you a few days prior to your appointment to explain the process of the myelography procedure. Make sure to inform the nurse of any and all medications that you are taking, especially blood-thinning medications.
  • The myelography procedure is done in the Radiology Dept by a Radiologist and Radiologic Technologist.
  • The Radiologist will explain the procedure and go over the consent with you. You will be required to read & sign a PATIENT CONSENT TO MEDICAL TREATMENT for the myelography procedure.
  • The entire process/procedure is usually completed within 60–90 minutes.
  • Once the procedure is complete, you will be transported by stretcher to the Same Day Surgery unit for about 2-4 hours post-procedure to be monitor by a Same Day Surgery Nurse and instructed to lie flat (head elevate no more than 30-45 degrees).

What will I experience during and after the procedure?

  • As the patient lies face-down on the examination table, the Radiologist will use fluoroscopic guidance, to visualize the spine and determine the best place to inject the contrast material.
  • During the exam, you will be asked to lay as still as possible while the table is tilted at different angles. A foot rest and straps or supports for your feet/ankles and shoulders will keep you from sliding out of position.
  • You may find the face-down position uncomfortable, however, you should not have to maintain this position for very long.
  • At the site of the injection, your back has been cleaned with an antiseptic, and sterile cloths (called drapes) will be placed around the area.
  • A local anesthetic (pain-relieving medication) will be injected into the area on your back. You will feel a brief sting when local anesthetic is injected under the skin and you will feel slight pressure on your back as the spinal needle is inserted. Positioning the needle can occasionally cause a sharp pain.
  • The needle is advanced, usually under fluoroscopic guidance, until its tip is positioned within the subarachnoid space within the spinal canal, at which time a free slow flow of fluid is obtained.

**If requested by the referring physician, a small amount of cerebrospinal fluid may be withdrawn and sent for laboratory studies.

  • The contrast material is then injected through the needle, the needle is removed and the skin at the puncture site is again cleaned. The patient is then positioned on the table, usually lying on their abdomen.
  • Again using the fluoroscope for guidance, the radiologist then slowly tilts the x-ray table allowing the contrast material to flow up or down within the subarachnoid space and to surround the nerve roots or the spinal cord.
  • As the table is tilted, the radiologist monitors the flow of contrast material with fluoroscopy, focusing on the area that correlates with the patient's symptoms.
  • Rarely, a patient may experience difficulty breathing deeply or swallowing when the table is tilted face down. If this should occur, please tell the radiologist or technologists and the table will be raised to a more comfortable position.
  • Headaches, flushing, or nausea may follow contrast injection, though this is rare. Seizures are also possible, but are very rare when the newer contrast materials are used.
  • The needle will be removed after the contrast has been injected. The area will be covered with a small bandage.
  • A computed tomography (CT) scan is frequently performed immediately following the conclusion of the myelography while contrast material is still present within the spinal canal. This combination of imaging studies is known as CT myelography.
  • A myelography examination is usually completed within 60–90 minutes. A CT scan will add another 15 to 30 minutes to the total examination time.
  • Following the conclusion of the myelography exam, the patient will be transported by stretcher to Same Day Surgery where vital signs and general patient conditions are observed for two to four hours, resting with the head elevated at a 30- to 45-degree angle for as long as four hours.
  • You may be encouraged to take fluids at this time to help eliminate the contrast material from your body and to prevent headache.
  • Following your Myelography procedure, you should refrain from strenuous physical activity and from bending over for one to two days. Rest when you feel tired so that you can recover well.
  • You should contact your referring physician to let them know that you have had the procedure and that you are waiting for the results. Be sure to talk to your physician about when you can resume taking your blood-thinning medications.

Although the risk of infection is extremely low, there are still some risks associated with a myelography procedure include pain or discomfort at the puncture site, infection, fever, headache, unusual drainage from puncture site. Contact your referring physician if you develop a fever or continue to feel pain for more than a few days. Patients should seek emergency care if they experience any of the following symptoms after the myelography procedure: pass out (lost consciousness), new or higher fever and a stiff neck, severe headache or sore back for more than 2 days, feel numb or lose strength below the puncture site.