Myelogram

What is a myelogram?

A
myelogram is a diagnostic imaging test generally done by a radiologist. It uses a
contrast dye and X-rays (fluoroscopy) or computed tomography (CT) to look for problems
in the spinal canal. Problems can develop in the spinal cord, nerve roots, and other
tissues. This test is also called myelography.

The contrast dye is injected into the spinal column before the procedure. The contrast dye appears on an X-ray screen allowing the radiologist to see the spinal cord, subarachnoid space, and other nearby structures more clearly than with standard X-rays of the spine.

The
radiologist may also use a CT scan when doing a myelogram. A CT scan is an imaging test
that uses X-rays and a computer to make detailed images of the body. A CT scan shows
detailed images of the spinal canal. CT scans show more details than standard
X-rays.

Why might I need a myelogram?

A myelogram may be done to assess the spinal cord, subarachnoid space, or other structures for changes or abnormalities. It may be used when another type of exam, such as a standard X-ray, does not give clear answers about the cause of back or spine problems. Myelograms may be used to evaluate many diseases, including:

  • Herniated disks. These are disks that bulge and press on nerves or the spinal
    cord.
  • Spinal
    cord tumors
  • Infection or inflammation of tissues around the spinal cord
  • Spinal
    stenosis. This is a breakdown and swelling of the bones and tissues around the spinal
    cord. This breakdown makes the canal narrow.
  • Bone
    spurs
  • Arthritic disks
  • Tumors
  • Cysts.
    These are noncancer (benign) capsules that may be filled with fluid or solid
    matter.
  • Tearing
    away or injury of spinal nerve roots
  • Arachnoiditis. This is inflammation of a delicate membrane that covers the nerve
    roots in the lower spine.

There may be other reasons for your healthcare provider to recommend a myelogram. Talk
with your healthcare provider about the reason for your test.

What are the risks of a myelogram?

You
may want to ask your healthcare provider about the amount of radiation used during the
procedure and the risks related to your situation. It’s a good idea to keep a record of
your radiation exposure, such as previous CT scans and other types of X-rays, so that
you can inform your healthcare provider. Risks associated with radiation exposure may be
related to the cumulative number of X-ray exams or treatments over a long period.

If you are pregnant or think you may be, tell your healthcare provider. Radiation exposure to the fetus may cause birth defects.

There is a risk of an allergic reaction to the contrast dye. Be sure to let your
healthcare provider know if you have any allergies, especially to shellfish or iodine,
ever had a reaction to any contrast dye, or have any kidney problems.

Because the contrast is injected into the cerebrospinal fluid (CSF) which also
surrounds the brain, there is a small risk of seizure after the injection. Some
medicines may place you at greater risk for seizure and you may be asked to stop taking
these for 48 hours before and after the study. Make sure your healthcare provider has a
list of all medicines (prescribed and over-the-counter) and all herbs, vitamins, and
supplements that you are taking.

Because this procedure involves a lumbar puncture, these potential complications may happen:

  • 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 entry point for bacteria.
  • Short-term numbness of the legs or lower back pain may be experienced.
  • There is
    a risk of bleeding in the spinal canal or in the soft tissues around it.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

How do I get ready for a myelogram?

  • Your
    healthcare provider will explain the procedure to you and ask if you have any
    questions.
  • 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 anything is not clear.
  • Follow
    any directions you are given for not eating or drinking before the test.
  • Tell
    your healthcare provider or the radiologist if you have ever had a reaction to any
    contrast dye or if you are allergic to iodine.
  • Tell your provider if you have a
    history of seizures or are taking any medicines for seizures.
  • Tell your provider if you have a
    history of bleeding disorders or are taking any blood-thinner (anticoagulant)
    medicine, aspirin, or other medicines that affect blood clotting. You may need to
    stop these medicines before the procedure.
  • Give
    your healthcare provider a list of all prescribed and over-the-counter medicines, and
    all herbs, vitamins, and supplements that you are taking.

If you have the procedure as an outpatient, you may be asked to stay in the hospital
for several hours afterward. Plan to have another person drive you home.

Your healthcare provider may give you other instructions on what to do before the
procedure.

What happens during a myelogram?

A myelogram may be done on an outpatient basis or as part of your stay in a hospital. The procedure takes about an hour, but may vary depending on your condition and the clinic’s practices.

Generally, a myelogram follows this process:

  1. You will be asked to remove any clothing, jewelry or other objects that may get in the way of the procedure.
  2. If you are asked to remove your clothing, you will be given a gown to wear.
  3. You will be reminded to empty your bladder before the start of the procedure.
  4. You
    will lie on our stomach or side on a padded table.
  5. Your back will be cleaned with an antiseptic solution and draped with sterile towels.
  6. The
    radiologist will numb the skin of your lower spine by injecting a numbing medicine
    using a thin needle. This injection may sting for a few seconds, but it makes the
    procedure less painful.
  7. A needle
    will be inserted through the numbed skin, between 2 spinal bones (vertebrae), and
    into the subarachnoid space where the spinal fluid is located. You will feel some
    pressure while the needle goes in, but it should not be painful. You must stay very
    still.
  8. The
    radiologist may remove some of the spinal fluid from the spinal canal. Next, a small
    amount of contrast dye will be injected into the spinal canal through the needle. You
    may feel a warming sensation and a metallic taste in your mouth when the contrast dye
    is injected. This should last only a few minutes. Then you will lie on your stomach,
    if you’re not already in this position.
  9. The X-ray table will be tilted in various directions to allow gravity to help 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 given during this process through the secured lumbar puncture needle.
  10. The
    needle is then removed and the X-rays or CT scan pictures are taken.
  11. You should tell the radiologist right away if you feel any numbness, tingling, headache, or lightheadedness during the procedure.

You
may have 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.