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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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