Myelogram

Authors: Prof Mark Khangure*
                            Dr Jason Wenderoth *

What are the generally accepted indications for a myelogram?

Myelography is becoming less common with the introduction of high quality magnetic resonance imaging (MRI). However, two indications remain for a myelogram

1. In patients who require imaging as a result of a clinical diagnosis of nerve root, thecal sac or spinal cord compression from disc, tumour or spinal stenosis, where MRI is:
   • contraindicated (see referrer information on MRI)
   • not possible (due to claustrophobia or large patient size)
   • diagnostically equivocal.
2. In patients with clinical symptoms and signs of a CSF leak.

What are the prerequisites for having a myelogram done?

When myelography is used to introduce contrast media to identify the site of a CSF leak, CT scanning is most often carried out both before and after the myelogram to pinpoint the site of leakage.

What are the absolute contraindications for a myelogram?

• Severe bleeding disorder.

What are the relative contraindications for a myelogram?

• Pregnancy.
• Uncooperative patient.
• Connective tissue disorder (such as Marfan’s and Ehlers-Danlos syndromes).
• Uncontrolled diabetes (ketoacidosis): nausea and vomiting can complicate post procedure care after myelography.

What are the adverse effects of a myelogram?

Immediate:

• Headache is common, resulting from CSF leak or intracranial contrast.
• Exacerbation of back and leg pain.
• Acute leg pain from nerve root trauma as a result of lumbar puncture.

Delayed:

• Posture related headache from persistent CSF leak.
• Arachnoiditis.
• Meningitis – infective or sterile.
• Skin and epidural infection.

Is there any specific post procedural care required following a myelogram?

• Bed rest for 24–48 hours.
• Plentiful fluid intake (non-alcoholic) – at least 3 litres per day.
  There is some evidence that caffeinated beverages may be beneficial in reducing the incidence of headache post- procedure.
• In general, anticoagulant drugs may be started the day following the procedure, but it is advised to check this with the radiologist on the day of the procedure.

Are there alternative imaging tests, interventions or surgical procedures to a myelogram?

An MRI scan and good quality CT scans have vastly reduced the need for myelograms. However, diagnosis of CSF leakage before surgery will often involve injection of iodinated contrast into the thecal sac for the purpose of determining the intracranial or spinal site of leakage using post-myelogram CT.

*The author has no conflict of interest with this topic.

Page last modified on 26/7/2017.