Background Information:

What are the other Names for the Procedure?

• Myelography

What is Myelogram radiology procedure? (General Explanation)

• Myelogram is an imaging procedure to study the anatomy of spinal cord, nerve roots, subarachnoid space, and the spinal column
• It involves inserting a spinal needle to inject contrast material into the subarachnoid space and the use of fluoroscopy to study the structures

What part of the Body does the Procedure involve?

Myelogram may involve the neck, upper back, middle back, or lower back, depending upon which area is to be examined.

Why is the Myelogram radiology procedure Performed?

Myelogram is performed as an alternative procedure to MRI in individuals in whom MRI is contradicted, due to the presence of some medical (metal) device such as a cardiac pacemaker.

• It is performed to detect abnormalities of the spinal cord, spinal canal, spinal nerve roots, and blood vessels supplying the spinal cord
• Myelogram can detect compression of nerve roots or spinal cord from intervertebral disk herniation
• It is also used to diagnose tumors, infection surrounding the spinal area, inflammation, and spinal lesions caused by trauma
• The procedure may also be ordered to identify spinal stenosis, where there is narrowing of the spinal canal, due to degeneration of bones, tissues, thickening of adjacent ligaments, or the presence of bony spurs (osteophytes)

What is the Equipment used? (Description of Equipment)

A Myelogram uses real-time X-ray imaging called fluoroscopy.

Fluoroscopy:

• An X-ray machine is used in fluoroscopy
• An examination table
• A monitor to view the examination in real-time

A fluoroscope converts the X-rays into video images and provides real-time video images, as the exam progresses.

What are the Recent Advances in the Procedure?

There have been no recent advances in the Myelogram procedure.

What is the Cost of performing the Myelogram radiology procedure?

The cost of a Myelogram procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary. 

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the Myelogram procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.ncbi.nlm.nih.gov/pubmed/25469084 (accessed on 07/20/2015)

http://www.ncbi.nlm.nih.gov/pubmed/25463397 (accessed on 07/20/2015)

http://www.ncbi.nlm.nih.gov/pubmed/25495513 (accessed on 07/20/2015)

Prior to Myelogram radiology procedure:

How does the Myelogram radiology procedure work?

The Myelogram procedure works in the following manner:

• An X-ray machine is used to produce images after contrast material has reached the targeted organs
• The X-ray machine passes radiation through the organs and images are produced on the monitor connected to the machine
• Fluoroscopy converts x-ray images into real-time images, which show the contrast material passing through the target region (subarachnoid space)

How is the Myelogram radiology procedure Performed?

The Myelogram procedure is performed on an outpatient basis in the following manner:

• The patient lies face down in prone position on the X-ray table
• Fluoroscopy is used to determine the best location where contrast material can be injected without damaging the spinal cord
• Once the site of injection is determined, a local anesthetic is injected to numb the area
• A needle is advanced using fluoroscopic guidance, until the tip of the needle is within the subarachnoid space, which is confirmed by the flow of fluid (the cerebrospinal fluid)
• A contrast material is (usually) injected in the lower lumbar region of the spinal canal, as the spinal cord ends at L2 and thus, is considered safe
• The x-ray table is tilted to let the contrast material flow freely into the subarachnoid space, so as to surround the nerve roots and spinal cord
• Once the area of concern is located, the patient may be repositioned to obtain better imaging scope and additional images are then taken
• A CT scan is often performed right after the Myelogram procedure to obtain additional images. In such a case, the entire procedure is known as CT Myelography
• Once the required images are taken, the table returns to a horizontal position. Patients may be asked to wait in the waiting area, until it is determined that no more images are required

Where is the Procedure Performed?

The Myelogram procedure is performed as an outpatient procedure, at a hospital.

Who Performs the Procedure?

A radiology technologist performs the Myelogram procedure under the supervision of a radiologist.

How long will the Procedure take?

• The Myelogram procedure takes about 30-60 minutes
• In case of CT Myelography, the CT scan takes an additional 15-30 minutes

Who interprets the Result?

The radiologist interprets the results of the Myelogram procedure.

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Myelogram procedure:

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
• Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
• Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
• It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the X-ray
• Women should notify the physician, if they are pregnant or breastfeeding their child; as many such procedures may not be performed on pregnant women
• The patient may be asked to avoid eating or drinking, several hours before the test
• It is recommended to notify the physician about any implants or metal objects in the body, such as a pacemaker, nerve simulators, surgical staples, or artificial heart valves, braces, or dyed tattoos, as they may interfere with the imaging, in some cases

What is the Consent Process before the Procedure?

A physician will request your consent for Myelogram procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent. 

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Myelogram procedure:

• Myelogram is a minimally-invasive and safe procedure
• It provides detailed information on the spinal cord, nerve roots, and subarachnoid space
• Radiation does not remain in the patient’s body after the procedure

Following are the risks of the Myelogram procedure:

• Contrast material used during the procedure may cause allergic reactions in some patients; nevertheless, it is very uncommon
• There is a (minimal) risk of nerve injury, due to spinal needle insertion into the subarachnoid space
• Seizures and inflammation of the meninges (membranes of the brain) are rare complications of a Myelogram
• Rarely, Myelogram can cause headaches that is associated with needle puncture:
  • The headache usually begins 2 or 3 days after the procedure
  • A common feature of this headache is that it improves when the individual is lying flat (horizontal), but gets worse in upright position
  • Mild headaches are relieved by lying on the back and increasing fluid intake
  • Severe and persistent headaches, in rare cases, may require medication or a simple procedure, called the epidural blood patch  
• In some very rare cases, radiation due to excessive exposure from x-ray fluoroscopy may cause cancer

What are the Limitations of the Myelogram radiology procedure?

Following are the limitations of the Myelogram procedure:

• An MRI scan is superior to Myelogram when it comes to visualizing an intrinsic spinal cord disease or disorder
• It is difficult to inject contrast material in patients with spinal injuries or structural defects of the spine
• Myelogram is only useful in visualization of the insides of the spinal canal and spinal nerve roots. It cannot be used to visualize areas outside of the spinal cord

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is a Myelogram procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
• Is there any medication that needs to be taken for life after the procedure?
• What are the costs involved?

During the Myelogram radiology procedure:

What is to be expected during the Myelogram radiology procedure?

The following may be expected during the Myelogram procedure:

• The patient may experience a little stinging sensation, when the local anesthetic is injected at the site of needle insertion
• A slight pressure may be experienced when the needle is inserted
• Patients are usually asked to notify their physician, if the pain radiates to another area of the body (such as down the leg)
• Patients are supported by straps to avoid them from sliding or falling from the table, while the table is tilted in different directions
• When the contrast material is injected, some patients may feel a warm sensation, headache, or nausea
• Once the procedure is performed, the patient is taken to the recovery area and observed for about 2 hours

What kind of Anesthesia is given, during the Procedure?

Anesthesia is rarely used during the Myelogram procedure.

How much Blood will you lose, during the Procedure?

Since the procedure is a minimally-invasive one, the blood loss involved during the procedure is minimal.

What are the possible Risks and Complications during the Myelogram radiology procedure?

• Contrast material used during the procedure may cause allergic reactions in some patients
• In very rare cases, a wrong needle insertion may cause severe damage of the spinal cord

What Post-Operative Care is needed at the Healthcare Facility after the Myelogram radiology procedure?

Patients are encouraged to drink plenty of fluids to eliminate the contrast material from the body, in order to avoid headache.

After the Myelogram radiology procedure:

What is to be expected after the Myelogram radiology procedure?

• Once the procedure is complete, patients are observed for approximately 2 hours, in the recovery area of the hospital
• The patient’s head is elevated to a 45 degree angle for a few hours

When do you need to call your Physician?

Patients should call their physician, if the patient experiences the following after the Myelogram procedure:

• Fever, greater than 100.4 degree F
• Excessive, persistent headache, nausea, or vomiting
• Neck stiffness
• Numbness in the extremities
• Urination or bowel movements signs and symptoms
• Redness, warmth, or any signs of infection at the area of needle insertion

What Post-Operative Care is needed at Home after the Myelogram radiology procedure?

• Patients are encouraged to drink plenty of fluid after the procedure to eliminate the contrast material from the body
• Patient should avoid any strenuous activities or bending over for 1-2 days, after the procedure

How long does it normally take to fully recover, from the Procedure?

It may take 1-2 days to completely recover from the Myelogram procedure and normal activities can be resumed after two days.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

Myelogram procedure does not involve the removal of any body tissue. 

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Myelogram radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the procedure is performed.