Myelography is an x-ray examination of the spinal canal. A contrast agent is injected through a needle into the space around the spinal cord to display the spinal cord, spinal canal, and nerve roots on an x ray.
The purpose of a myelogram is to evaluate the spinal cord and nerve roots for suspected compression. Pressure on these delicate structures causes pain or other symptoms. A myelogram is performed when precise detail about the spinal cord is needed to make a definitive diagnosis. In most cases, myelography is used after other studies, such as magnetic resonance imaging (MRI) or a computed tomography scan (CT), have not provided enough information to be certain of the diagnosis. Sometimes myelography followed by CT scan is an alternative for patients who cannot have an MRI scan, because they have a pacemaker or other implanted metallic device.
A herniated or ruptured intervertebral disc, or related condition such as disc bulge or protrusion, popularly known as a slipped disc, is one of the most common causes for pressure on the spinal cord or nerve roots. The condition is popularly known as a pinched nerve. Discs are pads of fiber and cartilage that contain rubbery tissue. They lie between the vertebrae, or individual bones, which make up the spine.
Discs act as cushions, accommodating strains, shocks, and position changes. A disc may rupture suddenly, due to injury or a sudden strain with the spine in an unnatural position. In other cases, the problem may come on gradually as a result of progressive deterioration of the discs with aging. The lower back is the most common area for this problem, but it sometimes occurs in the neck, and rarely in the upper back. A myelogram can help accurately locate the disc or discs involved.
Myelography may be used when a tumor is suspected. Tumors can originate in the spinal cord or in tissues surrounding the cord. Cancers that have started in other parts of the body may spread or metastasize in the spine. It is important to precisely locate the mass causing pressure so effective treatment can be undertaken. Patients with known cancer who develop back pain may require a myelogram for evaluation.
Other conditions that may be diagnosed using myelography include arthritic bony growths (spurs), narrowing of the spinal canal (spinal stenosis), or malformations of the spine.
Myelograms can be performed in a hospital x ray department or in an outpatient radiology facility. The patient lies face down on the x ray table. The radiologist first looks at the spine under fluoroscopy, and the images appear on a monitor screen. This is done to find the best location to position the needle. The skin is cleaned, numbed with local anesthetic, and then the needle is inserted. Occasionally, a small amount of cerebrospinal fluid, the clear fluid that surrounds the spinal cord and brain, may be withdrawn through the needle and sent for laboratory studies. Contrast material (dye that shows up on x rays) is then injected.
The x-ray table is tilted slowly, allowing the contrast material to reach different levels in the spinal canal. The flow is observed under fluoroscopy, and x rays are taken with the table tilted at various angles. A footrest and shoulder straps or supports keep the patient from sliding.
In many instances, a CT scan of the spine is performed immediately after a myelogram, while the contrast material is still in the spinal canal. This helps outline internal structures more clearly.
A myelogram takes approximately 30 to 60 minutes. A CT scan adds about another hour to the examination. If the procedure is done as an outpatient exam, some facilities prefer the patient to stay in a recovery area up to four hours.
Patients who are unable to lie still or cooperate with positioning should not have this examination. Severe congenital spinal abnormalities may make the examination technically difficult to carry out. Patients with a history of severe allergic reaction to contrast material (x-ray dye) should report this to their physician prior to having myelography. Medications to minimize the risk of severe reaction may be recommended before the procedure. Given the invasive nature and risks of myelograms and increased anatomic detail provided by MRI or CT, myelograms are generally not used as the first imaging test.
Patients should be well-hydrated at the time they are undergoing a myelogram. Increasing fluids the day before the study is usually recommended. All food and fluid intake should be stopped approximately four hours before the procedure.
Certain medications may need to be stopped for one to two days before myelography is performed. These include some antipsychotics, antidepressants, blood thinners, and diabetic medications. Patients should discuss this with their physician or the staff at the facility where the study is to be done.
Patients who smoke may be asked to stop the day before the test. This helps decrease the chance of nausea or headaches after the myelogram. Immediately before the examination, patients should empty their bowels and bladder.
After the examination is complete, the patient usually rests for several hours, with the head elevated. Extra fluids are encouraged, to help eliminate the contrast material and prevent headaches. A regular diet and routine medications may be resumed. Strenuous physical activities, especially those that involve bending over, may be discouraged for one or two days. The physician should be notified if the patient develops a fever, excessive nausea and vomiting, severe headache, or a stiff neck.
Headache is a common complication of myelography. It may begin several hours to several days after the examination. The cause is thought to be changes in cerebrospinal fluid pressure, not a reaction to the dye. The headache may be mild and easily alleviated with rest and increased fluids. Sometimes, nonprescription medicines are recommended. In some instances, the headache may be more severe and require stronger medication or other measures for relief. Many factors influence whether the patient develops this problem, including the type of the needle used and his or her age and gender. Patients with a history of chronic or recurrent headaches are more likely to develop a headache after a myelogram.
The chance of a reaction to the contrast material is a very small, but potentially significant risk. It is estimated that only 5–10% of patients experience any effect from contrast exposure. The vast majority of reactions are mild, such as sneezing, nausea, or anxiety. These usually resolve by themselves. A moderate reaction, like wheezing or hives, may be treated with medication, but is not considered life threatening. Severe reactions, such as heart or respiratory failure, occur very infrequently, and require emergency medical treatment.
Rare complications of myelography include injury to the nerve roots from the needle or from bleeding into the spaces around the roots. Inflammation of the delicate covering of the spinal cord, called arachnoiditis, or infections, can also occur. Seizures are another very uncommon complication reported after myelography.
A normal myelogram shows nerves that appear normal, and a spinal canal of normal width, with no areas of constriction or obstruction.
A myelogram may reveal a herniated disk, tumor, bone spurs, or narrowing of the spinal canal (spinal stenosis).
Daffner, Richard. Clinical Radiology, The Essentials. Baltimore: Williams and Wilkins, 1993.
Pagana, Kathleen Deska. Mosby's Manual of Diagnostic and Laboratory Tests. St. Louis: Mosby, Inc., 1998.
Torres, Lillian. Basic Medical Techniques and Patient Care in Imaging Technology. Philadelphia: Lippincott, 1997.
Spine Center. 1911 Arch St., Philadelphia, PA 19103. (215) 665-8300. http://www.thespinecenter.com
Ellen S. Weber, M.S.N.
Lee A. Shratter, M.D.
I can empathize with you!! Those are the WORST headaches! I had my first myleogram in '94. The next day I was back in the hosp (after lamenectomy) for 4 days. The blood patch didnt work and neither did the 'mega doses' of caffiene. Finally went away after 5 days. The next myleo was, again, before another lamenectomy (same place L4). The myleo went bad, it felt as if my right leg was blowing up like a balloon (excruciating pain!!!) and then it 'exploded'. I was screaming in pain and looked to see if my leg was still there and it was flopping up and down on the table. The 'intern' told me to lay still so he could move the needle and the same thing happened to the other leg. By then my body went into shock and they ran to get my Mom who was in the hall. it took 2 days to recover from the shock. The lamenectomy was preformed and all was well for 3 months until it re-ruptured. I was ignored for 8 mo and finally had a come to Jesus talk with my neurosurgeon. I had another myleogram (with no instances) and he referred me to someone 'better'. I had a fusion and screw and rods in 96. All was well till 04 and I ruptured a disc above the fusion. I DID file workmans comp and my prior orthopedic ordered a myleogram. (no immediate reactions) He also ordered spinal injections (something went wrong on the table) and about a week-2weeks later, I suddenly woke up w/a headache that worsened. By mid aft. my husband had called an ambulance. 4 days later I was told that some bacteria that everyone has on their skin, found its way into my spinal fluid. Bacterial menengitis! It made the CSF headaches feel like a tickle!! A month in the hospital. It turned into a circus, workmans comp was trying to get out of the mess as was the hosp. LONG LONG recovery!
I finally returned to another neurosurgeon 12-09 since that circus due to the pain getting worse due to my job. (havent filed workmans comp due to experience, or LACK there of. care) I had a myleogram 1-8-10. For 3 days I was telling everyone in radiology of my horrific experiences and not being able to lie on my stomach. Very high pain tolerance as well as high resistance to meds. I was barely lying on the table when the needle went in. I expressed the pain getting worse to no avail, and I literally scrambled all over the table, trying to grab my right let. My left leg was becoming paralized with pain and locked up. My IV came out, unbeknowest to me and I was screaming in agony and pain. They went to put me on a bed and I was screaming for someone to grab my left leg and pull it up. after the 3rd attempt, finally one of them complied and there was LITTLE relief. I then went into CT scan and into a room to 'recover'. Blood was all over my arms, hand, bed, gown from my IV. It has been 3 days now and my pain in my legs are finally decreasing. I GET NO RETURN CALL FROM THE DR. OFFICE. I put my PCP on alert that there were problems and release the report. I am experiencing hot/cold flashes today. have had bed rest since the tests.
I do not know why the med. profession will not take people seriously!!
Just thought I'd share my story.
Jeani
Mercedes Y. Thompson
4132 W. Virginia Ave. Apt1
Phoenix, AZ 85009
602-455-6499
To had insult to the injury they "lost the films" and asked me to repeat this test in a month. Never again. I am sure this procedure was done wrong. Now I have a phobia of all medical care. I know the fear is "unreasonable" it still exists.
I don't believe their story of the Burned conus.
Thanks for all the input from everyone.
Basically i had 2 severe accidents in the past one year.in the first accident i hurt my lower back(L5 S1) and in the second accident i was hit by a car(i was a pedestrian).second accident happened after 8 months.I had a spinal surgery 27 years back
Never had any complain before these accidants.I was working fine lifting weights .Not even a singe problem arises.
Now When these accidents happened --
first doctor asked me about my prior surgery.As i was not aware of what they did 27 years back and i was only 7 years of age at that time.Then they relate that u might have been injected Myelogram.I was not aware of. Soo in the first MRI report(first accidant) they states the pain could be from Trauma or could be from past surgery
I asked my parent they said no dye was injected.They know this becasue my brother had abdonmal surgery before me. he was injected dye.
Now after the second accident .My condition got worse.
I was getting shooting pains trouble flushing bowel
then i had another MRI scan.In that scan i was diagnosed with adhesive arachnoiditis.
? Now,Why for the past 27 years i had not even a single problem with my lower back and
? why archhandoities is only at L5S1 where i injured the most.
? 8 months back i was diagnosed with arachodoties which changes to adhesive arachanodities .
? Well my parents arew sure i was not injected any dye
? and how the doctor can reach to a conclusion that u have past surgery soo the problem is based on that surgery.How i lived perfectly for the past 27 years.Are they backing the big companies.and Neglecting the accidants Happened overthere.Sir please guide me
Pankajkhanna1@gmail.com
plz guide me how i can explain my doctors i never had complication b4 its because of accidant
I chose the hospital that I have recently found to have the best and newest equipment even if my deductible will be a small amount higher. The new procedure is uncomfortable from the standpoint that you do have to move from table to table and they want you to roll a bit to get the dye distributed as well as possible before the CT. But that being said, what a difference! The table is now tilted gently, you are not strapped in, the injections are quick and there was only a little nerve pain from those. Everyone was careful to make me as comfortable as possible. They took me straight to the CT, did that, and then to a recovery room with warm blankets and a big cup of hot coffee. I stayed there about an hour, and got some very detailed instructions about rest, positioning my head up that night, drinking lots of fluid, the possibilty of headache, etc. It's two days later, and I have not a trace of headache, no additional soreness except from the positions I had to take, and no reactions. I'm back to doing things just as before. Actually, this was a lot easier and much less painful than an epidural injection. I didn't have any tranquilizers or extra meds except for the anesthetic injected before the dye is placed.
Really, I feel for the folks who have had a bad experience, but I'm afraid those experiences show up more frequently. The ones like I just had aren't posted very often. They really aren't very exciting and you just move on. I am hoping my doctor appointment for tomorrow will give me some info about the new radicular pain I am having. I will ask for a copy of the radiology report for my own records, also. That has been a good thing to have in the event that doctors change or different hospitals are used. (I have had two laminectomies and three fusions, and am diagnosed with stenosis, nerve compression, degenerative disc disease, spondylistheses, and arthritic spurs. I also have developed some mild acquired lateral scoliosis. History of interventions over the past 15 years.) I hope this helps some people who are frightened of this test because many of us just don't have much trouble with it, and it is very helpful when other methods of finding dysfunction just don't work.
CT Mylogram, since then i have increased Left Lumbar pain,Left hip pain and left thigh & calf
pain what could have possibly happened during the CT Mylogram to cause this severe pain i am
having? Could you please help me?
The rest of the day went like clock work. Maybe 15 minutes in recovery and then on the way home. The rest of the night was Ok too. Tuesday morning I did have a Bear of a headache but after eating the cure all, chicken soup, the headache melted away and has not come back.
Bottom line do all you can to follow before and after instructions as closely and diligently as possible.
Good Luck.
There was a 100% difference between the two experiences. I had no sedation; the worst discomfort was the prick of the local needle. I had no headache afterward; in fact I'm amazed at how normal I feel. I'm taking it east, today, but I'm allowed to resume normal activity tomorrow.
Thank you, Dr. Fulp.
I have low back problems and have had a surgery on L5 and S1 several years ago (2008). The pain and problems are getting worse and worse. I pretty much have constant low back pain, a lot of shooting pains down both legs, numbing, tingling, burning down the backs on both legs, muscle spasms and just horrid pain. I can't sleep at night because of all this. Can't get comfortable. I've been falling in the house when I wasn't using my cane, so now I keep it with me at all times. I've been using a cane since the last car accident. The pain management doctor sent me back to the neurosurgeon and he is calling for the myelogram. The pain management doctor says I have 2 bulging discs and 4 pinched nerves on both sides of my lower back. I was in the hospital for 4 days for pain management in October after going to a chiropractor. They did 3 MRI's when I was in-patient then. All 3 sections of my back and neck. He sent me back to the neurosurgeon because he said I would benefit from decompression surgery.
Then I go to the neurosurgeon a couple weeks ago and he says it's not definite I have pinched nerves. Huh?? He thinks I have neuropathy from the back problems and diabetis. Possible fibromyalgia too, not sure. But he needs me to do this test to see if I definitely have the pinched nerves. When you have bulging discs isn't that where you get the pinched nerves??
I'm totally frustrated and tired of being in pain! That's an understatement really. I'm very scared about tomorrow's test. I remember when I had the myelogram before, when they put the dye in and had me strapped to the table. When they moved the table up and down I was moaning loudly in pain. Why would the dye cause such pain? What does that do to cause so much pain?
Then you lay there for a few hours flat. But I remember very clearly when they sat my head up OMG! I was screaming in pain from the migraine. This time because I warned them about my previous myelogram and the migraine they were ready. There was a doctor there injecting something into my IV. I think he had to do it a couple times for the pain from the instant migraine. When you have bad migraines to begin with does that make you more likely to get the migraine afterwards? This was the time I had to go to the ER the next day from the migraine.
I'm reading that drinking a lot of fluids today will help me for tomorrows test. Is that true? Anybody have any advice for tomorrow? The neurosurgeon will be there to give me the results he said. I certainly hope so. Don't feel like waiting after going thru all this for the results. I swore to myself last time I had the myelogram I'd NEVER do it again. But here we go again! He said he needs this test.
Is there a doctor there the whole time during the myelogram? It's a doctor that puts the needle in right? If I'm in terrible pain during the test will they give me anything for pain if I'm screaming? I will definitely tell them about the possibility of the migraine so they'll be ready. I'm in enough pain now I can't handle the excruciating pain during and after the test. Is the possibility of the fluid coming out when they put the needle in, is that where all the pain is from? Thank you for listening to me and any advice would greatly be appreciated.
Note: no activity the couple days following. I got up this morning and retrieved my truck from the hospitol. Bad idea. The bumps on the road and the sitting up and shifting were all aggravating the headache. Not a spinal leak thank God. But bad headache never the less.
I think a great staff made it alot better experience :)
I carried on having a mild headache every day for 6 months.
3 years later I needed another myelogram and was dreaded it but this time I drank the 3 litres of water and had my husband stay with me getting the commode when needed. I suffered no headache this time. The myelogram was inclusive so I had to have a MRI to confirm the results anyway so a wasted myelogram and worry
I have regular headaches and migraines every since and I have always wondered if the myelogram was the cause, after reading some of the comments on this page I think I might be right. I wish they would do a questionnaire by writing to the people who had these sort of things done in the past and if they have any after effects.
My myelogram experience: A lidocaine injection to the back inhibits the pain as the larger needle injects the dye. Once the dye is injected, pressure can be felt immediately. The Radiologist then moved the table and lowered my legs, I could feel the dye move and it felt as if dense "brownie batter" flowed into every available space within my legs. This was quite painful in both legs until the Radiologist moved the table back to a horizontal position and the pain slowly subsides. I was then tilted so that my head was pointed downward. The dye flowed into my head but fortunately not as dense as before but felt like a consistency of a thick "YooHoo". Of course, instant headache that was not relieved for about three days. Fortunately for me my headache was not excruciating but obviously not pleasant. The CT Scan followed without incident and I rested in the office for about 1.5 hrs following the 2.5 hr procedure(s) before going home. I've had multiple surgeries, multiple pain management therapies and chronic pain for over a decade. Sadly, I know pain intimately. I described this test to my husband as a "beast". I was given two days of steroids for pain and headaches following the procedure. It's been four days and I'm now back to my "normal pain". This is not a test that I would welcome in the future but I'm satisfied that the results showed my problem -- four more herniated disks (neck, thoracic and lower back). I just wanted to share my experience because I had no idea what to expect; which in hindsight may have been a good thing. My advice, stay positive and stay hydrated.
Doctor has suggested to my father for "CT Myelography" and pacemaker has placed for heart in his body, so so cannot go for MRI.
CT Myelography has some serious side effects. so please suggest me some other technique, that should not have serious risk like
meningitis. please help me.
Well, that is not true. I have rods, screws, and plate in lumbar spine that have not fused in 3 years. Titanium puts off a halo in the MRI and the CT scan, so my Neurologist needs this Myelogram I will have tomorrow in order to see what is pushing on the nerve root bundle and causing havoc. After my major lumbar surgery 3 years ago, it became infected, and as I was to leave the hospital in good shape, I was told that a second major surgery had to be done the next day to clean up the infection. It happens . . . so we move on. Research I have done indicates that if you have a major infection, there will be no fusion . . . as well as an unstable disc above (yep) . . . and often a 2nd lumbar surgery after one has failed may give short term good results followed by failure (yep). I have protocol of Prednisone and Benadryl because I am allergic to iodine. That is how important this test is to me. We need to find out what is happening in detail we cannot obtain any other way. I am praying I am one of the people who have no bad side effects. Keep in mind that thousands of these are done in the US daily and all the successful ones do not generate patients who come here to tell their good stories . . . only the relative small portion who have a bad experience come here to tell their tales - albeit important tales! When I had both of my knees replaced, I had to attend a class before the surgery. I was the only bilateral being done in the group, all others were getting one knee done. Six weeks later when I went to see my surgeon, I had to go to x-ray first. I bee bopped into the x-ray waiting room with no walking aids (had been down to a walker before replacements). I was surprised to see six of the people from the class, and they were all sporting their walkers or canes. They all looked at me practically dancing into the room and their shock registered on their faces. They all wanted to know how I had such huge success, and they had not. I asked them if they had followed the doctor's instructions for rehab exercises daily and religiously. They all looked to the floor in unison, and looked so sad. The window of doing the exercises is not more than a few weeks - do it or lose it. I learned something that day about why some people succeed and some people fail - attitude. I cried through those exercises the first 3 weeks - and wound up with a range of motion completely the same as I was at twenty.
Even though I see all of these bad posts, I know that there are thousands who have a good experience, and I am not only praying for a good experience, but I am counting on it.
If I'm bent over to long I can barely walk. Every night when I lay down my back pain is so bad that I am in tears until my back finally adjust.
Does anyone know what is going on? When it happens it fast and sharp and sometimes takes me to my knees. Feels like someone is stabbing me.
Layed at an angle all day which seemed to help. standing touse the bathroom caused pain to increase
I'll cont. to drink lots of fluids and rest hope and pray this goes away soon.
No cure, and no chance of getting the 'oil spots' out.
Neck
To have both my children with no epidural. Needless to say, I am absolutely terrified! Does a doctor do the procedure? A specialist? And what if they don't give me any meds! Do you get meds afterwards? I had a cervical fusion 18 months ago that has ruined my life, I am 46 years old and very limited to what I can do. pain is a daily beast in my life and I can't continue with this quality of life but after reading all this, is this just going to take more quality away? And if there is more pain than now, I truly can't live with it. Someone please please tell me something! Should I cancel my procedure? I am now crying uncontrollably and throwing up. I can't take this.
Wishing you a good experience. .
After much prayer I opted to go ahead with it. My conclusion is I wish I had never read all these reviews because my procedure was almost pain free with only moderate discomfort and no after effects not even a mild headache. Procedure done in a hospital in Hickory NC not in some prestigious university hospital and it still was painless. For those considering this procedure based on my experience...FEAR NOT!