Myelography

myelogram

What is Myelography?

Myelography, which is often termed as a myelogram, is a radiographic imaging process that is done to inspect the spine and the outer membrane surrounding it.

The process involves the injection of a radiographic contrast media or dye into the cerebrospinal fluid that surrounds the spine. The dye enhances the image quality of the nerve roots and spinal linings around the spine when the image is taken through an x-ray or a CT scan. In general, the entire process is also termed as fluoroscopy.

The radiologist views the passage of the contrast material through the subarachnoid space in real-time and also takes permanent pictures. This dye can clearly highlight the details of any abnormality like infections, tumors or inflammation affecting the area.

The test is generally accompanied by other tests like an MRI, CT scan and regular spinal x-ray films. Since the test involves the use of a dye, certain preparations and precautions are needed before it. The test is relatively painless and you will remain awake throughout the procedure. The test results are interpreted by a neuro-radiologist and the report is delivered to your doctor.

Why do I need to undergo a Myelography?

Myelography is used to obtain a clear image of the spine and the surrounding areas to study the exact nature of any back or spine-related problems. It is generally recommended for the following conditions.

Herniated discs may put pressure on the spine or the nerves.

– To detect any injury suffered by the spinal cord.

– Spinal disorders resulting in arm or leg pain, numbness, weakness, coordination problems and difficulty in walking.

– Spinal tumor, cysts or infections.

Spinal stenosis causes degeneration of the bones and tissues in the area.

– Any inflammation of the spinal cord membrane.

– Tearing away, deterioration or injury of spinal nerve roots.

– Spinal lesions caused by a specific disease or trauma.

Arachnoiditis which affects the membrane surrounding the brain.

– Arthritis in the spinal column.

– In conditions related to bone spurs and ankylosing spondylitis

For patients who have metal plates or screws in their spine, this method is preferred instead of a CT scan or an MRI. In many cases, a regular x-ray cannot detect the cause of a problem and myelography becomes necessary.

How is a Myelography performed?

The test needs some preparations beforehand and generally you will be called for a prior discussion to check any medications you might be taking and related instructions will be given.  When asked to undergo the test, you need to inform the doctor in case you have any one of the following conditions.

– If you have allergies to iodine or the contrast dye.

– In case you are pregnant or breastfeeding.

– Any history of bleeding disorders or if you are consuming blood thinners.

– In case you are consuming antibiotics related to a blood infection.

– Any history of epilepsy or seizures.

– Kidney problems or difficulty in urinating.

– Conditions like multiple myeloma, pheochromocytoma, homozygous sickle cell disease or thyroid disorders.

The equipment consists of x-ray tubes, a monitor and a detector that is placed over the table over which the patient lies. The test consists of the following steps in general.

– You will be asked to remove any jewelry or metallic objects from the body and change into a hospital gown. In some cases, it can be done while wearing normal clothing so it is best to wear non-restrictive, comfortable clothing.

– You will lie on your stomach on a padded surface and the site of the injection on your back will be sterilized and draped with sterile towels.

– A local anesthetic will be used to numb the area around the injection site to make the procedure painless. The radiologist will wait for some time to let the anaesthetic take effect.

– You will be asked to remain still when a needle is introduced in the subarachnoid space between two vertebras. A small amount of spinal fluid will be removed and the contrast dye will be injected inside. You might feel a warm sensation as the dye passes through your spine.

– The table might be moved or inclined to facilitate the passage of the dye through the spine. You will be kept secure by a harness.

– The technician uses a real-time video x-ray on the specified area of the spine. An MRI or a CAT scan can also be done immediately after myelography.

The entire procedure can take up to an hour to get completed. After the test is over, you will be moved to the observation area where you will be asked to lie down with your head in an elevated position. You should also not bend over in order to prevent the dye from getting inside your head and causing a headache. The resting period can last up to 4 hours during which you will be asked to consume fluids. You will be monitored by the staff and will be released after the initial recovery is complete.

What is the price for a Myelography procedure in India? 

The cost of the test in India varies depending on the exact nature of the test, the location and the quality of the facilities. It can range from Rs 3000 to Rs 10000.

When will I get the test results?

The test results are generally delivered within a day or two.

What is the normal range for a Myelography?

The neuro-radiologist will study the images generated from the test and will send a report to the doctor. In case of any abnormal findings, the same will be mentioned in the report.

Do I need to fast for the Myelography?

The doctor might ask you to fast for a few hours before the test.

What else do I need to know before I appear for a Myelography?

While undergoing myelography, the following points need to be kept in mind.

– Myelography is a relatively painless test though you may feel some minor discomfort during the insertion of the needle.

– It is necessary to drink a lot of fluids to flush the dye out of the system. The contrast dye is filtered by the kidneys and excreted through urine in the next couple of days.

– Consumption of alcohol should be avoided for the next 24 hours after the test.

– Arrange for someone to drive you home after the procedure since you should not drive by yourself.

– You will be exposed to some x-ray radiation during the procedure but that is too small to cause any damage.

– No strenuous activity should be undertaken in the next 24 hours and quick movements or bending over should be avoided for the next 48 hours.

– Do not lie flat or position your head lower than the rest of the body in the next 24 hours after the test.

Most patients do not suffer from any side effects after the test though some headache, pain or discomfort in the arms or legs, nausea, vomiting, and dizziness may occur in some cases. They usually disappear within 24 hours. In some rare cases, an allergic reaction to the dye or an infection of the meninges covering the spinal cord may occur.

In case you feel any numbness, tingling, headache or light-headedness during the procedure you should inform the radiologist. If any side effect continues beyond 24 hours or in case you develop a fever, it is best to contact the clinic or the doctor. Symptoms like numbness in the limbs, inability to urinate, blood or discharge from the injection site or a stiff neck should also be reported.

Can pregnant women undergo a Myelography?

Myelography is usually avoided during pregnancy due to the potential risk of exposing the fetus to radiation.

Is Myelography test possible for new-born babies?

Myelography can be done in new-borns when the doctor recommends it after analyzing the related pros and cons.

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