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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 constrast 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 that 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 medical provider order (Your medical provider may have already sent this to us.)
  • Personal identification
  • Insurance card(s)
  • Medication list and dosages

How to Prepare for Your Myelogram Exam

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

Some medications should be stopped one or two days before having a 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 medical provider 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, Novocain or latex. Allergic reactions to the contrast dye are rare but can occur. Be sure to tell your medical provider 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 you are pregnant or think you might be pregnant, you should 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 present 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 arrange 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 following day. 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 before your appointment to explain the process of the myelography procedure. Make sure to inform the nurse of all medications you are taking, especially blood-thinning medications.
  • The myelography procedure is done in the Radiology Department 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 and sign a PATIENT CONSENT TO MEDICAL TREATMENT for the myelography procedure.
  • The entire process, including the procedure, is usually completed within 60 — 90 minutes.
  • Once the procedure is complete, you will be transported by stretcher to the Same Day Surgery Center for about 2-4 hours after the procedure to be monitored by a Same Day Surgery nurse and instructed to lie flat (i.e., your head will be elevated no more than 30-45 degrees).

Key Points to Know During and After the Exam

  • You will be asked to lie on the examination table face down (on your stomach), and 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 footrest and straps (i.e., 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 will be 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 the 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 medical provider, a small amount of cerebrospinal fluid may be withdrawn and sent for laboratory studies.
  • The contrast material is then injected through the needle, and the needle is then removed. The skin at the puncture site will again be cleaned. You will then be positioned on the table, usually lying on your 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 your 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 imaging technologist, and the table will be raised to a more comfortable position.
  • Headaches, flushing and/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 after 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, you will be transported by stretcher to Same Day Surgery where vital signs and general patient conditions are observed for 2-4 hours, resting with your head elevated at a 30- to 45-degree angle for as long as 4 hours.
  • You may be encouraged to drink fluids at this time to help eliminate the contrast material from your body and to prevent a headache.
  • Following your myelography procedure, you should refrain from strenuous physical activity and from bending over for 1 to 2 days. Rest when you feel tired so you can recover well.
  • You should contact your referring medical provider to let them know you have had the procedure and that you are waiting for the results. Be sure to talk to your medical provider about when you can resume taking your blood-thinning medications.

IMPORTANT NOTE: Although the risk of infection is extremely low, there are still some risks associated with a myelography procedure that include pain or discomfort at the puncture site, as well as infection, fever, headache and unusual drainage from the puncture site. Contact your referring medical provider if you develop a fever or continue to feel pain for more than a few days. Please seek emergency care if you experience any of the following symptoms after the myelography procedure: loss of consciousness (i.e., pass out), new or higher temperature fever and a stiff neck, severe headache, sore back for more than 2 days, numbness or loss of strength below the puncture site.

TO SCHEDULE AN APPOINTMENT

Call us today at (985) 230-6790 to schedule an appointment.

If you are a provider and need to send an order, please send it via fax to (985) 230-6792.

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