What is Myelography?
Why do physicians order this procedure?
How do I prepare for the Myelogram?
What will the equipment used for my exam look like?
How is the procedure performed?
What should I expect during and after the procedure?
What are the benefits and risks of having a myelogram?
What are the limitations of Myelography?

What is Myelography?

Myelography is an examination of the fluid-filled sac that surrounds the spinal cord and nerve roots coming off the spinal cord. The sac is visualized by a contrast material that is injected into the sac.

The radiologist will observe the flow of contrast material from many angles to determine if there are obstructions in flow. The technologist will take several static x-rays following the radiologist’s portion of the test. Frequently, the myelogram is followed by a cat scan of the area while the contrast is still in the spinal sac.

Why do physicians order this procedure?

Myelography is used to determine the following:

- Diagnosis of anatomical problems with the spinal cord, spinal nerve roots, spinal canal and blood vessels that supply the spinal cord.

- To determine if herniations of the intervertebral disks are pressing against nerve roots or the spinal cord.

- To determine if bones surrounding the spinal canal have become degenerated to the extent that they are applying pressure to the spinal cord.

- Inflammation of the membrane covering the spinal cord

- Spinal lesions or tumors

- Infection (lab analysis of the spinal fluid)

How do I prepare for the Myelogram?

To prepare for the exam:
   
- Inform your physician of any medications you are taking. Drugs that should be stopped two days prior to the myelogram are antipsychotic medications, antidepressants and blood thinners. If you are diabetic and take Metformin, discontinue this drug for 48 hours following the Myelogram.

- Inform your physician of any substance, medicine or food allergies.

- Mention if you have an allergy to iodine or have experienced an allergic reaction to a previous x-ray/cat scan contrast (a reaction can be as minor as a rash). If you have had a previous reaction to x-ray/cat scan dye (contrast), your physician will want to pre-medicate you to lessen your sensitivity to the dye/contrast. This will involve taking a pill the day prior to the exam and again the day of the exam.

- If you are pregnant or think you could be pregnant, please notify your physician, the Imaging Department receptionist and the technologist performing your exam prior to the start of the exam. Some imaging tests are not recommended during pregnancy, especially during the first trimester.

- You will be asked to remove jewelry, some articles of clothing and possibly removable prosthetic devices.

- Avoid wearing clothing with buttons, snaps/hooks or metal zippers, if possible.

What to do prior to the myelogram:

- Drink three 8-ounce glasses of clear liquids between 7-9 p.m. the day prior to exam.

- Do not eat or drink anything after midnight the day prior to the exam.

- Off Glucophage/Metformin for 48 hours following the exam.

- If on blood thinners, the INR must be below 1.5.

- Need stat PT-PTT day of the exam.

What medications need to be discontinued 48 hours prior to and 24 hours following my myelogram?

Consult your personal physician prior to discontinuing any medications listed here.



What will the equipment used for my exam look like?

The equipment is comprised of a motorized table, a fluoroscope, x-ray tube and video monitor. The table will be hard and flat, so anticipate some discomfort, especially if you have difficulty lying on hard surfaces. The table has the capability of positioning you in either an upright (standing) position or a horizontal position.

How is the procedure performed?

This procedure is most often performed on an outpatient basis. It will be necessary for you to be NPO before the exam (do not eat or drink after dinner the night before the exam). Prior to starting the exam, the radiologist, technologist and you will review the exam to be performed to ensure that everyone is in agreement concerning the exam that is about to be performed.

You will be placed prone (face down) on the radiographic table. The radiologist will fluoroscope your spine to determine the safest and easiest area to inject the contrast material, usually the lower back area. While you are on the table, it will be tilted towards the head and feet to help the contrast flow up and down the spinal canal. The radiologist will take x-rays during this portion of the exam. The technologist will take additional static x-rays of the spine.

If your physician has also ordered a cat scan of your spine, you will have that procedure soon after the myelogram while the contrast is still in the spinal canal. The total exam usually takes about 45 to 60 minutes.

What should I expect during and after the procedure?

When you arrive at Liberty Hospital, you will report to the Registrations Department on the first floor. Following the registration process you will be taken to the Special Procedure area where you will be prepped for the myelogram. The myelographic examination will be performed in the Diagnostic Imaging Department by a radiologist and a radiologic technologist.

The radiologist will inject a local anesthetic in the area where the contrast will be injected into the spinal canal. You might feel a sharp pain when the needle used to inject the contrast is placed. If you feel a sharp pain going down one of your legs, tell the radiologist so he or she can make appropriate adjustments to the angle of the needle insertion.

The table will be angled toward your head and then toward your feet during the course of the myelographic examination. The radiologist will roll you from side to side and tilt the table while observing the column of contrast moving through the spinal canal. After all the pictures are taken, you will either be taken back to the Special Procedure Department for a three to four hour recovery or directly to the cat scan area for a scan of the spine area being studied. If you have a cat scan following the myelogram, you will be taken to Special Procedures for a 3-4 hour recovery.

Contact your physician if you experience a fever higher than 100.3 degrees F, excessive nausea or vomiting, severe headache for more than 24-hours, numbness in your legs or neck stiffness. You should also report any difficulty with urination or bowel movement.

What are the risks and benefits of having a myelogram?

- Myelography is a safe and painless exam.

- The contrast material helps the radiologist see abnormalities that are not seen during routine radiography.

- Some patients experience headache due to the loss of spinal fluid during the myelogram.

- You may experience a mild reaction to the contrast, but this is rare with non-ionic contrast.

- A woman should always inform the radiologist and/or radiology technologist if she may be pregnant.