What is a CT Myelogram?
A myelogram is an imaging procedure performed on an outpatient basis by a radiologist to diagnose medical conditions of the spinal canal, spinal cord and nerve roots. The procedure uses a combination of real time X-Ray imaging (fluoroscopy) and CAT Scans (CT) to evaluate these structures. During the examination a contrast material or "x-ray dye" will be introduced into the spinal column with the use of a spinal needle. The images obtained during the myelogram will allow your physician to evaluate and treat your medical condition.
Preparing for the myelogram:
Once you have been scheduled for a myelogram, a technologist from the SAMC Radiology Department will contact you to obtain a medical history, go over a list of your current medications, explain the procedure and answer any questions that you may have. When the technologist calls, please have a list of medications you currently take (prescription and non-prescription). Some medications must be held 48 hours prior to and 24 hours after the test. Failure to hold these medications could cause serious side effects such as seizures. To view these medications, click one of the following: Brand name medication list or Generic name medication list. Also inform the technologist if you have any allergies, especially to iodinated contrast material (x-ray dye). You may need to be pre-medicated for the procedure. If you are on blood thinning agents or anti-coagulant therapy such as: Coumadin, Warfarin, Plavix, Aggrenox, Xarelto, or others, these may need to be withheld for a period of time, and your physician may need to be contacted about stopping these. Inform the technologist if you are pregnant or possibly pregnant.
On the day of the procedure:
- Eat a light breakfast (cereal, toast, juice, coffee, water).
- Bring a list of all current medications with you.
- Arrive at SAMC Outpatient Registration at least 30 minutes before your appointment time.
- Once you have been taken to the Radiology Department, you will be asked to fill out our medication reconciliation form. Please list the date and time you took your medications last. The technologist will review this form prior to the procedure, and you will be given a copy upon discharge.
- Bring a responsible driver to take you home after the procedure.
- Expect to be at SAMC from 4 to 5 hours. This includes the myelogram, subsequent CT and recovery period.
During the procedure:
You will be taken to a dressing room to change into a gown. The technologist will escort you to the fluoroscopy suite and take a blood pressure reading. Next, you will sign forms giving the radiologist permission to perform the myelogram. You will be assisted to the X-ray table and positioned for preliminary x-rays. Then, the technologist will prepare you for the procedure. You will be asked to lie on your abdomen for the procedure; if this is uncomfortable cushions can be applied to ease the discomfort. Every effort will be made to make you comfortable and to complete the exam as quickly as possible. An area on your back will be exposed and cleansed using an antiseptic solution. Sterile drapes will be applied to reduce the risk of infection. A local anesthetic, such as lidocaine will be injected into the skin for numbing. This may feel like a pinch or burning sensation. Next, the spinal needle will be guided into the spinal space using fluoroscopic (x-ray) guidance. This may feel like mild pressure in your lower back, or you may notice nothing at all. A small amount of contrast ("x-ray dye"), about 10-20mL, will be injected slowly into the spinal column containing the nerve roots. You may experience sensations of pressure, cramping, tingling or an increase in your previous symptoms. This is normal and will ease off within a few hours. Once the contrast is in place the needle will be removed, and images will be obtained. Images will be taken while being tilted on the table in different directions; you may be tilted down towards your head or tilted to stand onto your feet. Tilting the table allows gravity to move the contrast to the desired location for images to be obtained. Once all images required by the radiologist have been taken, your back will once again be cleansed, and you will be moved to a stretcher to be taken for a CAT Scan (CT). The myelogram takes approximately 30-45 minutes to be performed. The CT will take approximately 10-15 minutes, and you will recover in a room on the second floor in our same day surgery area for approximately 2 to 4 hours.
After the procedure:
Upon discharge you will be given post procedure instructions and a copy of your medication reconciliation form to take home with you. It is important to follow all instructions carefully to prevent any complications such as: headaches, seizures and pain. Post instructions include:
- 24 hours bed rest. You may not return to work or participate in strenuous activities within this time period.
- No driving or operating machinery for 24 hours.
- Continue holding contraindicated medications for 24 hours post procedure
- Stay well hydrated, drink plenty of fluids.
How will I get the test results?
The Radiologist will review all images, and send a report to your ordering physician within 24 hours. Your physician will talk with you about your test results at the time of your follow up appointment.
Are there any risks?
Myelograms are very safe procedures done on an outpatient basis with minimal possible risks. With any procedure involving a needle there is always a risk for infection, this risk is very low, and sterile technique is used to significantly reduce this risk. Allergic reactions to the contrast material are extremely uncommon, but may occur. Allergic reactions may be mild to severe. Mild reactions include: itching, nausea and hives. A more severe reaction would include: nausea, shortness of breath, difficulty breathing or swallowing. Reactions to the contrast typically happen immediately after injection. There is a low risk for a "spinal headache." This is a headache that will not be relieved using medications. This headache is caused by a leaking of the spinal fluid from the injection site. Following the bed rest protocol for 24 hours will reduce this risk. There is a risk for bleeding. This risk is especially low if you are not on blood thinning agents. Blood thinners are held due to this concern. A risk for seizures is also uncommon, but may occur if you are on a contraindicated medication. Certain medications may put you at an increased risk. Please let the technologist know about all medications you currently take.
What are the benefits?
Myelograms use high resolution imaging of the spinal column for a detailed study that can assist your physician in evaluating your medical condition and diagnosing abnormalities of the spine. Myelography may be used in planning for surgical treatment of the spine. These high detailed images help to demonstrate:
- Compression of nerve roots caused by herniations of intervertebral discs
- Degenerative Changes in the bone and tissues surrounding the spinal canal
- Spinal stenosis
- Tumors involving the spine, nerve roots or spinal cord
- Infections involving the spine, the discs or surrounding tissues
- Spinal lesions caused by disease or trauma
- Spinal fluid leaks
How do I contact someone about my concerns?
You may contact our radiology department directly at (334) 793-8843 to speak to a Radiologic Technologist about your procedure. Please call between the hours of 7 a.m. to 4 p.m. If you develop problems after the procedure, call your ordering Physician. If you have an emergency, call 911 or proceed to the nearest emergency room.