Understanding Medical Tests: Myelography

Myelography (myelogram) is a diagnostic test that uses a radiographic contrast media (dye) that is injected into the spinal canal’s fluid (cerebrospinal fluid, CSF). The dye visually enhances the spinal canal, spinal cord, and nerve roots when x-rayed or imaged using CT (Computed Tomography).

A myelogram may be performed to help find the cause of symptoms and diagnose a spinal disorder.

• Arm or leg pain, numbness, weakness
• Coordination problems, difficulty walking
• Herniated or other disc disorder
• Spinal stenosis
• Spinal tumor or infection
• Inflammation of the spinal cord membrane
• Spinal vascular problems

Some doctors prefer myelogram with CT to diagnose different spinal conditions, such as disc herniation, spinal stenosis, tumor, or vertebral fracture. CT provides more detail than x-ray.

Preparation

Myelography is performed in a medical center or hospital x-ray department. Pre-test instructions include:

• Arrange for someone to drive you home after the procedure.
• Do not eat or drink anything after midnight the night before the test.
• Leave your jewelry and valuables at home.
• Bring prior imaging studies with you (x-ray, CT, MRI).

Special Considerations

• If you take medication to control diabetes or seizures, or take blood thinners, discuss the need for medication with your doctor well in advance of your test date. Certain drugs should be stopped 24- to 48-hours before the test.
  
  
• Tell the radiology technician if you:
  - Are allergic to IVP (intravenous pyelography) or other contrast dye
  - Suffer angina, kidney disorder, epilepsy, or seizure
  
  
• Bring a list of your medications (names and dosages) and supplements (vitamins, herbs) you take.

Myelography Procedure

Myelgraphy involves two main steps: injecting contrast media (dye) into the spine and imaging the results.

The injection of the contrast media is sometimes referred to as a cervical or lumbar puncture. Before the puncture begins, your body is properly positioned.

• Cervical Puncture
  Your are positioned on your back.
  
  
• Lumbar Puncture
  You are positioned on your side with your knees tucked up under your chin, or as close to the chin as possible. Bringing the knees up under your chin creates more space between the vertebrae.

Next, the skin area is cleansed using an antiseptic. A local anesthetic numbs the area. Fluoroscopy (real time x-ray) is used to guide the needle into the spine and monitor the injection and spread of the contrast within the CSF and around the spinal cord and nerve roots. The table may be tilted to help move the contrast media where needed.

After the Procedure

After the procedure, you are transferred to the observation area. When discharged home, written instructions may include:

• Keep your head elevated and do not bend over or lie flat. This will keep the contrast from spreading into your head and possibly causing headache.
• Rest for 8-hours
• Drink plenty of fluids
• Do not exercise the same day as the procedure
• Notify your doctor if you develop increased headache or drowsiness, a fever, seizures, or extremity weakness

Possible Side Effects

Most patients do not experience any side effects after myelography. The most common side effect is headache, which usually clears up in a day or two with rest and fluids. Other side effects include nausea, dizziness, generalized achiness, seizure, or infection (rare).

If side effects develop and become bothersome, please contact our office.