Myelography

By Author: Sajid Latif
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Myelography

What is myelography?

Myelography is a procedure that is undertaken to help diagnose the causes of back ache and problems with the spinal cord (this is the structure in the backbone that transmits electrical signals from the brain to the nerves).

Why is myelography performed?

Myelography is the preferred technique for detecting abnormal blood vessels surrounding the spinal cord. Although myelography has been largely superseded by magnetic resonance imaging (MRI; see separate Factsheet), it is often able to detect these when MRI has failed to do so. Indeed, MRI is sometimes not possible if a person has metal implants or a pacemaker in their body, or is claustrophobic within the confined space of the MRI scanner.

What happens during myelography?

Myelography is usually performed by a radiologist. This is a doctor who has specialised in X-ray techniques. The myelogram itself involves the injection of a liquid that shows up on X-rays into the back. This liquid then bathes the space surrounding the spinal cord, allowing the spinal cord and surrounding structures to be seen more ...
... easily with X-rays.

The doctor will ask you to lie on your left side and will open your gown at the back. A small patch of skin on your back will be cleaned with antiseptic solution. A small amount of local anaesthetic will be injected into your skin between the bones at the lower end of the back. A needle is then introduced between these bones and the special liquid is injected. You will then be tilted on a special table allowing the fluid to pass up and down the spinal canal. X-rays are then taken from a variety of angles.

What should I expect at the hospital?

On arrival, you will be seen by a nurse and then a doctor who will examine you. The myelogram will then usually be performed later that day in the hospital's X-ray department.

What are the possible complications?

Myelography performed by an experienced radiologist is a safe procedure with a very low incidence of side effects. There is usually some discomfort at the time of the procedure. This largely relates to the injection of local anaesthetic in the back which can sometimes sting. The insertion of the needle is usually painless and the patient often only experiences a 'pushing' sensation in the lower back.

The main side effect of the procedure is a headache. This usually comes on 24 to 48 hours after the procedure and may occur in up to one-quarter of all patients. It can be severe and associated with nausea and vomiting. It is usually caused by a slow leak of the fluid around the spinal cord through the needle track. The headache is usually self-limiting and improves within five days to a week. It can be prevented by encouraging bed rest after the procedure and also by drinking plenty of fluids. If the headaches are severe and prolonged, they can sometimes be improved by the administration of steroid tablets for a short period of time.

In the past, the fluid injected was an oily substance which was not easily absorbed by the body after the procedure. This meant that myelography would sometimes result in severe lower back pain that was often very difficult to treat. Over the past 15 years, however, more soluble fluids have been used that are much more easily absorbed by the body. They provide excellent images of the spinal canal and spinal cord and are not associated with this complication.

What happens after the myelography?

Myelography may be performed as a day case; if so, you will be allowed to go home after resting for 6-8 hours. Alternatively, you might stay in hospital overnight and go home the next morning.

Myelography is usually a painless procedure, although it is sometimes mildly uncomfortable. The side effects are uncommon and rarely require treatment.

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