MYLEOGRAM OF THE SPINE

Myelogram of the Spine

A myelogram, an older test, examines the spinal canal and spinal cord. The doctor injects a special dye into the spinal sac that will indicate any abnormalities on X-rays. Before there were CT and MRI scans, the myelogram was the best test to determine the cause of pressure on the spinal cord or spinal nerves. Today the myelogram only gets used for very special purposes, such as for complicated revision spine surgeries. If you have a herniated disc, it rarely becomes the first test used.

Why do doctors order this test?

The dye used during a myelogram outlines the spinal cord and nerve roots. This helps your doctor see any unusual indentations or abnormal shapes in the spinal cord. Anything that pushes into the nerves shows up as an indentation in the spinal sac. This indentation could originate from a herniated or bulging disc, a tumor, or an injury to the spinal nerve roots. For patients who possess metal plates and screws in their spine, the myelogram becomes the first choice because metal prevents MRI scans.  

Before a Myelography

Before undergoing myelography, it’s crucial to inform your physician about specific medical conditions and situations to ensure your safety and the procedure’s efficacy. Make sure to discuss the following:

Existing Medical Conditions

• Allergies: Highlight any allergies you possess, particularly to contrast media, latex, or any other substances.
• Heart Issues: Mention if a doctor diagnosed you with angina or any other heart problems.
• Epilepsy: If you suffer from epilepsy, please tell the doctor.

Medications and Treatments

• Blood Thinners: Let your doctor know if you are taking any anticoagulant medications.
• Diabetes: Inform the physician about your diabetes and any medications you are taking for it.

Current Physical Conditions

• Kidney Disease: Report any kidney issues, as these can affect the use of contrast media.
• Difficulty Urinating: Mention if you experience a problem with urination.

Special Circumstances

• Pregnancy: Notify the staff if you are pregnant. Myelography will not be conducted during pregnancy because of the potential radiation risk to the baby.
• Breastfeeding: If you are breastfeeding, please tell your doctor.
• Mobility Issues: Discuss any difficulties you experience when lying on your stomach or remaining still for extended periods.

By providing this information, you help your healthcare provider take the necessary precautions and tailor the procedure to your individual needs, ensuring the best possible outcome.

How Should You Prepare for a Myelography Test?

Preparing for a myelography test requires careful planning and adherence to specific guidelines to ensure your safety and the accuracy of the test results. Follow these preparation steps:

• Arrange Transportation: Ensure someone will drive you to and from the facility where the test will take place. The test can affect your ability to drive safely.

Pre-Appointment Checklist

Previous Medical Records:

• Bring Relevant Scans: Gather copies of past imaging studies such as X-rays, CT scans, or MRIs. The radiologist may want these to compare with the new images.

Fasting Guidelines:

• No Solid Food: Do not consume any solid food after midnight before your appointment.
• Clear Liquids: Drinking clear liquids (like water) is usually permitted, but always check with your physician for any specific restrictions.

Medication Instructions

• Continue Medications Carefully: On the day of the test, you may need to take your prescribed medications with clear liquids, unless otherwise instructed by your doctor. Confirm these details in advance to avoid any complications.

Personal Belongings

• Avoid Valuables: It’s advised to leave jewelry and other valuables at home to prevent any loss or interference during the procedure.

General Tips

• Follow Doctor’s Instructions: Always adhere strictly to the guidelines provided by your healthcare provider. Each patient may receive personalized instructions based on their medical condition.

By following these steps, you can help ensure a smooth and successful myelography test experience.

Who Typically Performs a Myelography Test?

A myelography test is generally conducted by a specialized medical professional known as a neuroradiologist. This type of radiologist received advanced training and expertise in imaging techniques specifically focused on the nervous system and spine.

How to Conduct a Myelogram of the Spine

The doctor must perform a spinal tap to inject dye into the spinal space. The dye mixes with the spinal fluid so that it will show up on X-rays. You will lie on a tilting table while multiple X-rays are taken to show the flow of the dye through the spine. Doctors usually combine the myelogram with a CT scan to get a better view of the spine in cross-section and to check the health of the bones and nerves.

Step-by-Step Procedure

• Preparation:
  After changing into a gown, the staff will position you on your stomach or side for the injection.
• The injection area of the skin is cleansed thoroughly.

Numbing the Area:

• A numbing medication is injected to help make the procedure more comfortable.
• You might feel a sting or gentle pressure as the needle is inserted. Some patients report sharp but momentary pain.

Injection of Contrast Medium:

• Once the area is numb, the contrast medium (dye) is injected into the spinal sac.
• The dye mixes with the spinal fluid to enhance visibility on X-rays.

Imaging:

• The neuroradiologist uses fluoroscopy—real-time video X-ray—to ensure the contrast medium flows into the targeted area of the spine.
• Multiple X-rays are taken to show the flow of the dye through the spine.
• The myelogram is usually combined with a CT scan to get a better view of the spine in cross-section and to assess the health of the bones and nerves.

By following these detailed steps, the myelogram provides a comprehensive view of the spine, aiding in the diagnosis and treatment of spinal conditions.

What are the limitations?

A myelogram does not show the soft tissues. It shows only the bones and the spinal fluid where the dye mixes with the fluid.

What are the risks?

Because the myelogram requires a spinal tap, there are more risks associated with it than with most other tests. This provides one reason that doctors prefer to use “noninvasive” tests first, such as MRI and CT> scans. Although the risks associated with a spinal tap are rare, they include meningitis (infection of the spinal fluid), spinal headache, and allergic reaction to the dye. However, the needle might cause bleeding around the spinal sac. Meanwhile, the myelogram requires X-rays, which use radiation, and large doses of radiation can increase the risk of cancer. Finally, the vast majority of patients who have X-rays taken will never get enough radiation to worry about cancer. Only patients who have large numbers of X-rays — hundreds over many years — should take notice.

Common Side Effects

In addition to the risks mentioned above, there are also common side effects that patients might experience. These include:

• Headache
• Aches or discomfort in the arms or legs
• Nausea
• Vomiting
• Dizziness

Most patients do not experience any side effects, and when they do occur, they usually disappear within 24 hours.

Spinal Headache: What to Expect

Although uncommon, a headache related to the needle puncture, often called a “spinal headache,” can occur after a myelogram. Typically, this headache begins when the patient sits up or stands, and one telltale feature is that it feels better when lying flat. If a headache does occur, it usually starts within two to three days after the procedure.

Mild spinal headaches often respond well to rest (while lying on your back) and drinking extra fluids. Sometimes, medication may be needed for more severe headaches. In rare cases, if the headache doesn’t go away, a simple procedure called an epidural blood patch can be performed to help resolve it.

What Aftercare is Required Following a Myelography Procedure?

After a myelography procedure, precise aftercare steps are essential to ensure proper recovery. Here’s what you need to know:
Immediate Recovery:

• After the procedure, you will go to a recovery area where you’ll need to rest for up to four hours. This period is crucial for monitoring your initial response to the procedure.

Positioning During Recovery:

• Some patients may rest with their heads elevated. This can help mitigate certain side effects and ensure comfort.

Monitoring:

• The radiology staff will closely observe you throughout this recovery period to ensure that no immediate complications arise.

Discharge Instructions:

• Activity Restrictions: Avoid strenuous activities for the first 24 hours. Also, refrain from bending movements for 48 hours to prevent complications.
• Hydration: It’s important to drink plenty of fluids, such as water or juice. This helps flush the contrast dye from your system.
• Breastfeeding Considerations: If you are breastfeeding, you might give your baby formula for a short duration after the test to ensure safety.

By adhering to these aftercare instructions, you can help ensure a smoother recovery after your myelography.

When to Contact a Physician

If side effects persist longer than 24 hours, or if you develop a fever over 100.4 degrees F, it is important to contact your physician, the hospital, or the radiology clinic where the test was performed. This ensures that any potential complications are addressed promptly.

Balancing Risks and Benefits

While patients should learn about the risks and side effects associated with myelography, it’s important to balance these against the benefits of the test. Myelography can provide critical information that other tests cannot provide. Furthermore, that data can aid in an accurate diagnosis for treatment planning. Always discuss any concerns with your healthcare provider to make an informed decision about the procedure.

Understanding the Costs Associated with a Myelogram

When considering a myelogram, you should know about the various costs involved. Here’s a breakdown of what you might expect:

• Technical Fee: This covers the cost of performing the test itself. This charge is typically from the hospital or clinic where the procedure is done.
• Professional Fee: After the test, a specialist, often a radiologist, will interpret the results. The fee associated with this service is known as the professional fee. Once your myelogram is complete, the radiologist—who is specially trained to supervise and analyze imaging studies—will review the images and prepare a detailed report. This report is then sent to your primary doctor or the healthcare provider managing your care, who will discuss the findings with you and explain what they mean for your diagnosis or treatment plan. In some cases, your doctor may recommend a follow-up exam. This might further evaluate a particular area, obtain additional imaging from different angles, or monitor any changes over time. Follow-up exams are sometimes the best way to see if a treatment is effective or if a specific concern requires more attention.

Additional expenses could arise from laboratory tests on the fluid extracted during the spinal tap.

These lab tests might incur separate charges. Therefore, you might receive multiple bills, including:

• A bill from the hospital or clinic for the technical aspect of the myelogram.
• A bill from the specialist for interpreting the test results.
• A potential bill for any laboratory tests conducted on the spinal fluid.

Understanding these distinct costs can help you better prepare for the financial aspects when talking to your insurance company about undergoing a myelogram.

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The medical content on this page has been carefully reviewed and approved for accuracy by the Southwest Scoliosis and Spine Institute’s qualified healthcare professionals, including our board-certified physicians and Physician Assistants. Our team ensures that all information reflects the latest evidence-based practices and meets rigorous standards of medical accuracy, with oversight from our expert spine doctors to guarantee reliability for our patients.