Dr. Tigran Khachatryan, MD, PhD.

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Myelogram

What is a Myelogram?

A myelogram is a special imaging test that provides a detailed CT image of your spinal cord, nerves, and the discs between your vertebrae. During the procedure, a special dye, also called contrast material, is injected into the fluid-filled sac around your spinal cord. This dye helps the spinal cord, nerves, and surrounding structures show up more clearly on X-rays or a Computed Tomography (CT) scan. It allows your doctor to see issues that a regular CT might not reveal and can show how your bones and discs relate to your spinal cord and nerves.

You might hear about specific types like a cervical myelogram (for your neck) or a lumbar myelogram (for your lower back); these simply refer to the area of your spine being examined.

Why Your Doctor Might Order a Myelogram

Doctors often recommend a myelogram to get more information, especially if other imaging tests like a CT scan or MRI haven’t fully explained your chronic back pain or other symptoms. It’s particularly useful for diagnosing conditions such as:

  • Bulging (herniated) discs, where the soft cushions between your backbones press on nerves.
  • Arthritis in your spinal joints.
  • Spinal narrowing (spinal stenosis), which occurs when the spaces in your spine become smaller and press on your spinal cord or nerves.
  • Bone spurs.
  • Spinal tumors or infections around the spinal cord.
  • If you have new or persistent pain or weakness after a recent spinal surgery.

Your doctor might also order a myelogram if you experience symptoms like back, neck, or leg pain, tingling sensations, weakness, or difficulty with walking or fine motor tasks. While MRI scans often provide similar information, a myelogram can be a necessary alternative for people who cannot have an MRI due to certain medical devices like a pacemaker or due to claustrophobia. It can also sometimes offer a clearer view of specific areas like nerve root compression or the width of the spinal canal. Discovering a site of cerebrospinal fluid leakage is another possible indication.

Getting Ready for Your Myelogram

Preparation is key for a smooth procedure. Your healthcare team will provide specific instructions, but here are general guidelines:

  • Arrange for Transportation: You will need someone to drive you to and from your appointment and be available to help you for at least 12 hours after the exam. You should not drive until the day after your procedure.
  • Clothing: Wear loose, comfortable clothing to your appointment.
  • Allergies: Inform your doctor and the imaging staff about any allergies you have, especially to medications, contrast dye, local numbing medicine, Betadine soap, or latex.

Medications:

  • Discuss all medications with your healthcare provider.
  • Certain medications, such as blood thinners (like Coumadin, Heparin, Lovenox, aspirin, or anti-inflammatory pain relievers like NSAIDs), may need to be stopped 2 to 5 days before the procedure. Your doctor will advise you on when to stop and restart these.
  • If you take medications that can lower your seizure threshold (e.g., certain antidepressants, Zyban, antipsychotics, muscle relaxers), these must be stopped at least 48 hours before the procedure and not resumed until 24 hours afterward. A nurse will likely call you to confirm and provide instructions.
  • Take your other normal medicines as prescribed, unless instructed otherwise.

Food and Drink:

  • Do not eat any solid food after midnight on the day of your procedure.
  • You can drink clear fluids (water, clear broth, tea without cream, black coffee, fruit juice without pulp, clear soda) up to 6 hours before your test.
  • It's recommended to drink plenty of clear fluids (4 to 8 ounces every two hours) the day before your test.
  • Avoid caffeine and alcohol on the day of the procedure.
  • Pregnancy: If you are pregnant or think you might be, inform your physician, the technologist, and the radiologist immediately. X-rays are typically avoided during pregnancy unless the benefits significantly outweigh the risks to the baby.
  • Lab Tests: You might need blood tests (to check blood count and clotting ability) within two weeks before the procedure, and routine X-rays of your spine might also be performed.

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What Happens During the Myelogram Procedure?

The myelogram is performed by a specialty-trained doctor who specializes in medical imaging. The entire process, from check-in to recovery, usually takes about two to three hours, with the actual imaging lasting about 30 to 60 minutes. Here’s a general overview:

  • After registration, you'll have a brief history and physical exam, and an IV might be placed.
  • You will lie on an exam table, usually on your stomach or side.
  • Your lower back will be cleaned with an antiseptic solution, and a local numbing medicine will be injected into your skin. You might feel a brief sting from the numbing medicine.
  • Once the area is numb, a thin needle will be carefully placed into the fluid-filled sac around your spinal nerves. You may feel some pressure, and occasionally a brief electric shock sensation down your leg. This is due to electrical stimulation of the nerve but not a nerve damage, and does not have lasting side effects. If this happens, the needle position will be adjusted.
  • The special contrast dye will then be injected. During this, you might feel a warm or flushed sensation, a metallic taste in your mouth, or temporary nausea. A sample of your spinal fluid might also be collected for further testing.
  • After the injection, the needle will be removed and puncture site covered with a dressing. The exam table may be tilted in different directions, and you might be asked to move your head to help the dye flow to the specific area needing imaging.
  • Multiple X-ray images will be taken, and a CT scan is routinely performed immediately afterward to gather additional detailed information.
  • You will be awake throughout the procedure and can ask questions or report symptoms. Intravenous sedative medications may be given to help you feel relaxed.

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After Your Myelogram: Postoperative Care

Proper care after your myelogram is important for your recovery and to minimize side effects:

  • Rest: You will lie down for about 60 minutes before leaving the clinic or hospital. For the remainder of the day, stay as quiet as possible and rest. You should stay in bed overnight with minimal activity. Avoid strenuous activity or heavy lifting for 24 hours, and do not return to work until the next day.
  • Head Position: It is crucial to keep your head elevated for 24 hours. Use two pillows or keep your head raised at about a 30-degree angle. This helps reduce the chance of getting a headache. You may get up to use the bathroom and sit up to eat.
  • Fluids and Alcohol: Drink plenty of non-alcoholic liquids—at least four 8-ounce glasses in the 8 hours after the procedure, and aim for at least 64 ounces daily for two days. Do not drink alcoholic beverages for at least 24 hours.
  • Diet: Return to your normal diet, following any specific instructions from your healthcare provider.
  • Pain Relief: Take your normal medicines, including pain relievers, as instructed. Over-the-counter pain relievers and caffeinated drinks may help alleviate headaches.
  • Injection Site Care: Bandages were placed over the injection site. You may remove these after 24 hours and take a shower. Keep the site clean and dry. Do not swim or soak in a bathtub or hot tub for one week.
  • Medication Resumption: Discuss with your doctor when to restart any blood thinners or anti-seizure medications you paused before the procedure.

Understanding Your Results

After your myelogram, a doctor specializing in medical imaging (radiologist) will review the images and create a detailed report. This report will be sent to the doctor who ordered your test, usually within a few days. Your referring doctor will then contact you to discuss the results, explain what they mean for your condition, and outline any next steps or treatment plans. Any spinal fluid collected during the procedure will also be sent to a lab for analysis, which may take several days.

  • If your results are normal, it means your spinal canal and structures appeared to be of normal size, position, and shape. However, your doctor may still recommend further tests to determine the cause of your symptoms.
  • If your results are not normal, it could indicate conditions such as a bulging disc, spinal narrowing, a tumor, nerve injury, bone spurs, or inflammation of the spinal cord's covering membrane.

Possible Complications and When to Call Your Doctor

While myelograms are generally safe, it’s important to be aware of possible side effects and complications:

Common Side Effects:

  • The most common side effect is a headache, which can range from mild to severe and may last hours to days. It often worsens when sitting or standing upright and may improve when lying flat.
  • Mild soreness at the injection site is expected and typically lasts for a few hours or, in rare cases, up to a few days.
  • Nausea and vomiting can also occur.
  • You might experience temporary worsening of back or leg pain.

Headache Specific Advice: If your headache improves when you lie flat, you should rest flat in bed for 24 to 48 hours. If the headache is severe or does not get better after lying flat and drinking extra liquids for 24 hours, it could indicate a spinal fluid leak. In this case, you must contact your healthcare provider immediately. Caffeinated beverages may help reduce the incidence of headaches.

When to Call Your Healthcare Provider Immediately: Contact your healthcare provider or the facility where you had the procedure right away if you experience any of the following:

  • Nausea with vomiting (throwing up).
  • A severe headache that doesn't go away.
  • Unusual sleepiness or confusion.
  • Redness or drainage at the puncture site.
  • Chills or a temperature of 101 F (38.3 C) or higher.
  • Tingling, numbness, or loss of sensation in your legs or bottom.
  • Difficulty moving your bowels or bladder, or an inability to urinate.
  • Fainting.
  • Any other questions or concerns.

Rare but Serious Complications: These are uncommon but can include infection at the injection site, bleeding leading to swelling, temporary loss of sensation or muscle strength, injury to structures near the needle (minimized by imaging guidance), an allergic reaction to the contrast dye (ranging from itching to severe cardiac or respiratory issues), or seizures.

Summary

A myelogram is a valuable imaging test used to obtain detailed pictures of your spinal cord, nerves, and discs using a special dye and X-rays or CT scans. It helps diagnose various spinal conditions, especially when other tests haven’t provided enough information, or if you cannot undergo an MRI. Preparing properly, understanding the procedure, and following postoperative care instructions are crucial for your safety and recovery. While common side effects like headaches and soreness are usually manageable, it’s important to be aware of more serious symptoms and contact your healthcare provider immediately if they arise. Your doctor will discuss the results with you to determine the best path forward for your health.