What is a myelogram?
A myelogram is a diagnostic imaging procedure done by a radiologist. It uses a contrast dye and X-rays or computed tomography (CT) to look for problems in the spinal canal, including the spinal cord, nerve roots, and other tissues. It is also known as myelography.
The contrast dye is injected into the spinal column before the procedure. The contrast dye appears on an X-ray screen, allowing the radiologist to see the spinal cord, subarachnoid space, and other nearby structures more clearly than with standard X-rays of the spine.
The radiologist will also use a CT scan when doing a myelogram. A CT or CAT scan is a diagnostic imaging procedure using a combination of X-rays and computer technology to produce horizontal, or axial, images of the body. These images, called slices, show detailed images of the spinal canal. CT scans provide more detail than standard X-rays.
Click image to enlarge
Anatomy of the spine
The spinal column is made up of 33 vertebrae that are separated by spongy disks and classified into distinct areas.
The cervical area consists of seven vertebrae in the neck.
The thoracic area consists of 12 vertebrae in the chest area.
The lumbar area consists of five vertebrae in the lower back area.
The sacrum has five, small fused vertebrae.
The four coccygeal vertebrae fuse to form one bone, called the coccyx or tailbone.
The spinal cord, a major part of the central nervous system, is located in the vertebral canal and reaches from the base of the skull to the upper part of the lower back. The bones of the spine and a sac containing cerebrospinal fluid surround it. The spinal cord carries sensory and movement signals to and from the brain and controls many reflexes.
Why might I need a myelogram?
A myelogram may be performed to assess the spinal cord, subarachnoid space, or other structures for abnormalities, particularly when another type of examination, such as a standard X-ray, is inconclusive. Myelograms may be used to evaluate many diseases, including, but not limited to, the following:
Herniated discs (discs that bulge and press on nerves and/or the spinal cord)
Spinal cord or brain tumors
Infection and/or inflammation of tissues around the spinal cord and brain
Spinal stenosis (degeneration and swelling of the bones and tissue around the spinal cord that make the canal narrow)
Ankylosing spondylitis (a disease that affects the spine, causing bones to grow together)
Degenerative disc disease
Cysts (benign capsules that may be filled with fluid)
Tearing away or injury of spinal nerve roots
Arachnoiditis (inflammation of a delicate membrane covering the brain)
There may be other reasons for your doctor to recommend a myelogram.
What are the risks of a myelogram?
You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your radiation exposure, such as previous scans and other types of X-rays, so that you can tell your doctor. Risks associated with radiation exposure may be related to the cumulative number of X-ray examinations and/or treatments over a long period of time.
If you are pregnant or think you may be, tell your doctor. Radiation exposure to the fetus may cause birth defects.
Because a contrast dye is used during the procedure, there is risk of allergic reaction to the substance. You will need to let your doctor know if you have ever had a reaction to any contrast.
Because the contrast is injected into the cerebrospinal fluid which also surrounds the brain, there is a small risk of seizure after the injection. Some medications may place you at greater risk for seizure and you may be asked to stop taking a medication for 48 hours before and after the study.
Because this procedure involves a lumbar puncture, the following potential complications may occur:
A small amount of CSF can leak from the needle insertion site. This can cause headaches after the procedure. If there is a persistent leak the headache can be severe.
There is a slight risk of infection because the needle breaks the skin's surface, providing a possible portal of entry for bacteria.
A temporary numbness to the legs or lower back pain may be experienced.
There is a risk of bleeding in the spinal canal.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
How do I prepare for a myelogram?
If you are having a myelogram at Johns Hopkins radiology, a neuroradiology doctor will contact you by phone two or three days prior to your scheduled myelogram to discuss the procedure and answer any questions.
Please inform the neuroradiology doctor if you are:
On antibiotics - you may need to wait to do the procedure. If you have an active infection or fever, you will need to reschedule the procedure.
Allergic to IV contrast used in CT scanning, latex or local anesthetics
On anticoagulant therapy (blood thinners)
On antidepressants/antianxiety medication
On antipsychotic medication
OTHER PRECAUTIONS: If you are pregnant or think you may be pregnant, please check with your doctor before scheduling the exam. Other options will be discussed with you and your doctor.
If you are diabetic, you should contact the doctor treating you for diabetes regarding possible medication changes the day of the procedure. If you are on metformin, you will need to stop taking it for a period of 48 hours after the myelogram.
CLOTHING: You must completely change into a patient gown. A locker will be provided for you to secure personal belongings. Please remove all piercings and leave all jewelry and valuables at home.
CONTRAST MEDIA: The contrast media improves the radiologist's ability to find structures that may be abnormal. Some patients should not have an iodine-based contrast media. If you have problems with your kidney function, please inform us in advance. You will be asked to sign a consent form that will detail the risks and side-effects associated with the myelogram.
ALLERGY: Please inform the access center representative when you schedule your scan if you have had an allergic reaction to any contrast media in the past. The contrast will not be administered if you have had a severe or anaphylactic reaction to any iodinated contrast media. Mild to moderate reactions warrant a plan that includes taking medication prior to the examination. These plans will be discussed with you in detail when you schedule your exam. Any known reactions to a contrast media should be discussed with your personal physician.
EAT/DRINK: Do not eat or drink anything three hours prior to your myelogram. You may have water to take your medications. Please limit the amount of water to only what is needed to comfortably swallow the medication.
MEDICATION: Please bring a current list of your medication and allergies with you.
Medications that must be stopped 48 hours before your myelogram:
Combination tranquilizer and antidepressant
Medications with MAO inhibition activity
Tramadol, ryzolt, ultram, ultracet
Diabetic medication - contact your doctor treating your diabetes regarding possible medication changes the day of the procedure. You should not take metformin for 48 hours after your myelogram.
TRAVEL: You should be accompanied by an adult driver to they can drive you home after the procedure. This is for your safety and comfort.
PLEASE NOTE: You will be unabe to drive 24 hours after the procedure. If you are taking a cab or riding the bus, you need to bring a friend or family member to accompany you after the procedure to your home or hotel. A cab or bus driver is not considered an escort.
If your ride home is longer than 30 minutes, we advise that on your ride home you be in a reclined position with one or two pillows supporting your head.
Arrive one hour prior to your appointment time to allow time to be prepared for the procedure.
Based on your medical condition, your doctor may request other specific preparation.
Click image to enlarge
What happens during a myelogram?
A myelogram may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.
Generally, a myelogram follows this process:
You will be asked to remove any clothing, jewelry or other objects that may interfere with the procedure.
You will be given a gown to wear.
You will be reminded to empty your bladder prior to the start of the procedure.
During the procedure, you will lie on your stomach on a padded table.
Your back will be cleaned with an antiseptic solution and draped with sterile towels.
The radiologist will numb the skin by injecting a local anesthetic that numbs the site. This injection may sting for a few seconds, but makes the procedure less painful.
A needle will be inserted through the numbed skin and into the subarachnoid space where the spinal fluid is located. You may feel some pressure while the needle is inserted, but you must stay still during the insertion of the needle.
The radiologist will remove some of the spinal fluid from the spinal canal. Next, a portion of contrast dye will be injected into the spinal canal through the needle. You may feel a warming sensation when the contrast dye is injected.
The X-ray table will be tilted in various directions to allow gravity to move the contrast dye to different areas of your spinal cord. You will be held in place by a special brace or harness. More contrast may be given during this process through the secured lumbar puncture needle.
The needle is removed and the X-rays or CT scan pictures are taken.
Tell the radiologist right away if you feel any numbness, tingling, headache, or lightheadedness during the procedure.
You may experience discomfort during the myelogram. The radiologist will use all possible comfort measures and complete the procedure as quickly as possible to minimize any discomfort or pain.
What happens after a myelogram?
You should remain in the lying position for several hours after the procedure to reduce your risk of developing a CSF leak.
You will be asked to drink additional fluids to rehydrate after the procedure. This helps to replace the spinal fluid that was withdrawn and reduces the chance of developing a headache.
A nurse will monitor your vital signs (blood pressure, temperature, pulse, and respirations) frequently after the test. Analgesic agents may be administered if you develop a headache.
When you have completed the recovery period, you will be taken to your hospital room or discharged to your home.
Once you are at home, notify your doctor of any abnormalities, such as numbness and tingling of the legs, blood or other drainage from the injection site, pain at or near the injection site, inability to urinate, fever, stiff neck, or headaches. If the headaches persist for more than 24 hours after the procedure, or when you change positions, you should contact your doctor.
You may be instructed to limit your activity for 24 hours following the procedure. Generally, if no complications occur, you may return to your normal diet and activities.
Your doctor may give you additional or alternative instructions after the procedure, depending on your particular situation.