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Myelography
Your Doctor has referred you to Neuroroadiology
for a myelogram. This x-ray examination produces images (films) of
your spinal cord and spinal nerves after contrast (sometimes called
"dye") is injected into the fluid within the spinal column. Myelography
can diagnose specific abnormalities such as herniated discs, spinal
canal narrowing, and tumors. These images will assist your physician
in evaluating your medical condition.
Personnel
A team composed of physicians (neuroradiologists), technologists,
and nurses will be involved in your procedure. Members of this team
will explain the procedure to you beforehand. Please feel free to
ask questions.
Before the Procedure
Please see the list of drugs at the end of this sheet which MUST be
stopped 2 days prior to your myelogram!
INPATIENTS: The day prior to your myelography, you may be visited
by a member of our staff who will review the procedure with you and
discuss the procedure including its benefits, alternatives, and risks.
In the event you are admitted the day of your myelogram, we will attempt
to call you at home (or hotel) the day prior to discuss the procedure.
If you will not be home at least the day prior to your myelogram and
are being admitted following the procedure, please contact us at 410-955-7432
between 8:00 am and 4:30 pm to discuss the procedure and ask any questions.
If you are taking anti-coagulants such
as coumadin (warfarin) or lovenox or heparin, you must consult with
your physician about stopping these drugs prior to your myelogram.
Because we are placing a needle into your spine, it would be safest
if you were not taking any blood thinners at the time of the myelogram.
You will be able to restart your anticoagulants the day after the
study. Please contact the physician who is prescribing these medications
to determine how many days prior to the myelogram you should stop
your medication. In some cases you may need to have your coagulation
factors checked by having blood drawn to make sure your blood clotting
values are safe.
On the day of your procedure, we ask
that you not eat solid food for three hours before the test. However,
you are encouraged to drink liquids (juices, soft drinks, water, coffee,
and tea) before your myelogram. You may take your regular medications
as prescribed unless otherwise directed by our team.
OUTPATIENTS: For your safety and comfort, you will be expected to
have a relative or friend accompany you, especially for your return
home. The day before the examination, a member of our staff will attempt
to contact you by phone to discuss the procedure with you and answer
any questions. If you do not plan to be home at least the day before
the examination, please contact our office in advance between 8:00
am and 4:30 pm at (410) 955-7432.
The Procedure
The technologist will ask you to lie on your abdomen on the myelographic
table. He or she will adjust a pillow to cushion you comfortably.
Your weight will be supported by very strong velcro straps that hold
you to the table safely. An area of your back or neck will be cleansed
with an antiseptic which may feel cool. The neuroradiologist will
then inject a local anesthetic to numb a small area of skin. Using
x-ray (fluoroscopy) guidance, the neuroradiologist will then place
the spinal needle into the spinal fluid bathing the spinal cord and
inject the contrast dye through this small needle into your spinal
fluid. The contrast may be injected either in the lower back or the
upper side of the neck. Which route is selected is determined by the
neuroradiologist after reviewing your medical problem and records.
Occasionally, your physician may request that spinal fluid be obtained
for laboratory tests prior to injecting the contrast material. After
injecting the contrast dye, the spinal needle is removed. A bandaid
is applied.
X-rays are taken as the contrast outlines the spinal cord and nerves.
As you are lying on the myelographic table, the table may be tilted.
You will be supported by the velcro straps. This is done so that the
contrast will move upward or downward. After x-ray films of the spinal
region are taken, the patient is prepared for a CT scan of the spine.
We would like to reassure you that this procedure usually causes little
discomfort.
After the Procedure
Following the myelogram, you will be assisted onto a stretcher and
positioned with your head raised at least 30 degrees. In almost all
cases, a CT scan follows the myelogram to obtain even further information
about the spine while the dye is still present in the spinal fluid.
There may be a short time span between the myelogram and the spinal
CT scan or several hours will pass before the scan is begun. This
is determined by how much contrast is used. When CT scanning is to
occur right after the myelogram, you will wait in the Neuroradiology
Department. Inpatients may be returned to their room and scanned several
hours later. Images will be evaluated by the neuroradiologist. A copy
of the report will be sent to your referring physician.
After Leaving Neuroradiology
INPATIENTS: You will be returned to your room on a stretcher A nurse
will assist you into bed where you should rest quietly for at least
8 hours, other than sitting in a chair for short periods, or getting
up for use of the bathroom. We recommend that while in bed, you lie
with the head of the bed elevated at least 30 degrees. During these
8 hours after the myelography/ CT scan, please do not bend over. Drinking
plenty of liquids after the procedure is also very helpful. Solid
foods may be eaten later as desired. Following the 8 hour period,
you may resume normal activity if you are feeling well. If you experience
a headache, it is best to remain in bed at this time for another 8
to 10 hours.
OUTPATIENTS: After the myelogram is complete, you must be remain in
the neuroradiology area at bed rest and to be monitored by our nursing
staff for approximately 2 hours to reduce the risk of post-procedural
headache or allergic reaction. Your CT scan may be performed during
this time. After the observation period and the CT scan you may be driven
home by a friend or relative. Plan to have someone with you to drive you home.
Taxi drivers are not a good substitute and will not look after you the
way a significant other will. If your ride home is longer than 30 minutes,
we advise that you spend this time in your automobile in a reclined
position with 1-2 pillows supporting your head. After returning home,
please rest 8 hours on a couch or bed, supporting your head with at
least two pillows.
Potential Side Effects
The most common side effect from this procedure is a headache, and
this head ache can be quite severe and last days after the spinal
tap. In order to minimize the chance of a headache developing you
should restrict all activity for the day of the myelogram. The longer
you rest in bed, the less likely you will have this very bad headache.
If your headache lasts more than 24 hours call us at 410-955-7432 and
we may suggest you get an epidural blood patch which will relieve your
headache quickly. This can be done at JHH or any nearby medical facility.
Other side effects include nausea/vomiting, exacerbation of pain,
and dizziness. These symptoms may result from either the spinal tap
or the contrast which is injected. Our use of the smallest sized needles
and the injection of the smallest amount of contrast possible result
in our patients having experienced a low occurrence of the side effects.
When side effects occur, they usually last less than 24 hours and
are usually not dangerous. If you have any questions or concerns about
the after effects, please call 410-955-7432.
Concerned about X-rays?
Please be aware that radiation use and patient protection is an important
part of the training and experience of radiology personnel. Be assured
that the necessary information is obtained using the minimum of x-rays.
If you notice that the staff wear leaded aprons, it is because they
work with x-rays everyday and their occupational exposure is high.
Pregnancy
If there is any possibility that you could be pregnant, please inform
your physician and a member of the Neuroradiology staff before your
procedure.
THE FOLLOWING ARE DRUGS WHICH MUST BE DISCONTINUED FOR 48 HRS PRIOR
TO MYELOGRAPHY
Anti-Coagulants
Coumadin
Warfarin
Lovenox
Heparin
Major Tranquilizers/ Anti-Psychotics
Dartal - thiopropozate
Repoise - butaperazine
Compazine - prochlorperazine
Quide - piperacetazine
Haidol - haloperidol
Serentil - mesoridazine
Inapsine - droperidol
Sparine - promazine
Largon - propriomazine
Stelazine - trifluoperazine
Levoprome - methotrimeprazine
Tacaryl - methdilazine
Loxitane - loxapine
Taractan - chlorprothixene
Mellaril - thioridizine
Temaril - trimeprazine
Moban - molindone
Thorazine - chlorpromazine
Nazane - thiothixene
Tigan - trimethobenzamide
Parsidol - ethopropazine
Tindal - acetophenazine
Phenergan - promethazine
Torecan - triethylperazine
Trilafon - perphenaxine
Prolixin, Permatil - fluphenazine
Vesprin - triflupromazin
Antidepressants/ Anti-Anxiety
Adapin - doxepin
Norpramin - desipramine
Asedin - amoazpine
Pamelor - nortriptyline
Atarax* - hydroxyzine
Pertrofrane - desipramine
Aventyl - nortriptyline
Sinequan - doxepin
Buspar- buspirone
Surmontil - trimipramine
Deprol - meprobamate
Tofranil - Imipramine
Desyrel - trazodone
Trancopyl - chlormezanone
Elavil,Endep - amitriptyline
Vistaril* - hydroxyzine
Ludiomil - maprotiline
Vivactil - protriptyline
Miltowne - meprobamat
*Use 48 hours before a myelogram is to be discouraged, but a myelogram
may be performed while the patient is on this drug.
Combination Tranquilizer and Anti-depressant
Deprol - Meprobamate & benactyzine
Etrafon - perphenazine &amitriptyline
Limbitrol - chlordiazepoxide&amitriptyline
Triavil - perphenazine & amitriptyline
MAO Inhibitors
Eutonyl - pargyline
Matulane - procarbazine
Furoxone - furazolidone
Nardil - phenelzine
Marpian - isocarboxazide
Parnate - tranyleypromine
CNS Stimulants
Aminophylline - aminophylline
Metrazol - pentylenetetrazone
Aromatic Ammonia - Ammonia
Plegine, Strychnine - phendimetrazine
Benzedrine - amphetamine
Pondimin - felfluramine
Coramine - nikethamide
Preludin - phenmetrazine
Cylert - pernoline
Picrotoxon - phenmetrazine
Dexedrine - dextroamphetamine
Pre-Sate - chlorphentermine
Didrex - benzphetamine
Ritalin - methylphenidate
Dopram - doxapram
Sanores - mazindol
Ienamin - phentermine
Tenuate, Tepanil - diethylpropion
Methadrine - methampheiamine
Voranil - chortermine
* ALSO PROZAC, ZOLOFT, PAXIL, SERZONE, TETRACYCLIC ANTI-DEPRESSANTS
(PAMOLAR)
Additional Information
For additional
information on the web, we recommend you click on the link below to
visit the ACR and RSNA patient information site:
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