Myelogram

Your doctor has requested that you have a myelogram. We hope that the following information will answer some of the questions you may have about this examination.

What is a myelogram?

A myelogram is an x-ray examination of the spinal cord and the space surrounding it. It provides a very detailed picture of the spinal cord and spinal column and of any abnormalities that may be present such as herniated or ruptured intervertebral disc.

Contrast medium (or ‘X-ray dye’) is injected via a small needle into the lower part of the spine. This is done by a radiologist (a doctor who specialises in X-rays used for diagnosis) into the fluid filled space around the spine called the subarachnoid space. This is called a lumbar puncture or LP.

The table used for a myelogram can be tilted so that contrast medium will run up and down within this space and surround the nerve roots that enter and exit the spinal cord.

Images are then taken as the contrast medium flows into the various areas of the spine. Far more information can be obtained from a myelogram than from plain spine X-rays.

Why do I need to have a myelogram?

A myelogram is performed when other tests such as Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) have not provided enough information, or when patients cannot have an MRI for any reason.

How do I prepare for the examination?

It is important that you drink plenty of fluids before your myelogram to help remove the contrast medium from your body and to prevent headache. You may also eat light meals prior to the procedure.

If you are on any medication which thins the blood (e.g. aspirin, clopidogrel, warfarin, rivaroxaban, apixaban, dabigatran) we ask you to call the Imaging department on the number on your appointment letter as we may need to adjust your medication before undergoing this procedure.

These may need to be adjusted to keep the risk of bleeding to a minimum.

On the day of the procedure

You will arrive at the Imaging Department (Gate 19) and be accompanied to our day case area.

Please inform us if you have any allergies or if you think there is a chance you may be pregnant.

You will then be asked to change into a hospital gown.

Once all the checks have been performed, you will be taken to the X-ray room on the trolley. There will be a doctor, radiographer and imaging support worker with you throughout the procedure.

What will happen during the procedure?

Before the examination begins, the radiologist will explain what they are going to do. You will be given the opportunity to ask any questions you may have.
If you are happy to proceed you will be asked to sign a consent form.
You will then be asked to lie on your front on the X-ray couch.
The skin on your back will be cleaned and a small amount of local anaesthetic will be injected under the skin. This stings for a few seconds and the area then goes numb.
A very fine spinal needle will be guided into the correct place using the X-ray machine. If needed, a small amount of cerebral spinal fluid can be withdrawn for laboratory studies.
When the contrast medium is injected, you may feel slight pressure. It is common to experience heavy legs and a momentary increase in symptoms. Headache, flushing or nausea are other symptoms you may experience following the contrast injection.
The X-ray table is slowly tilted to different angles and X-ray pictures are taken. Rests and straps (or supports) will keep you from sliding out of position.
A CT scan is often performed after the myelogam while contrast is still present in the spinal canal. You will be brought to the CT scanner on the trolley.

Are there any risks associated with a myelogram?

Generally it is a very safe procedure. Potential complications are uncommon and include:

Bleeding or haematoma (a bruise under the skin) around the injection site. (This should settle down by itself).
Infection. Contact your GP if you experience any redness or tenderness at the injection site.
An allergic reaction to the contrast medium. (RCR 2015). Please inform the radiologist performing the myelogram if you have any allergies.
Headache (see information about this below).

X-rays are used in this procedure but with modern equipment the risk is low (NRPB 2014).

It is important that patients inform the Imaging Department if there is any possibility of pregnancy before attending for the examination.

Will I experience any serious side effects?

Serious side effects are rare but you should notify your GP if you experience:

A high fever
Excessive nausea and vomiting
Severe headache for more than 24 hours
Neck stiffness
Numbness in your legs
Trouble urinating or passing a stool.

Who interprets the results and how do I get them?

The results will not be available at the time of your myelogram.

The radiologist, who performed your myelogram, will examine your images in detail and forward a report to the doctor who referred you for the myelogram. You will be able to get the results from this doctor.

We hope this information is helpful. If you have any questions either before, during or after the procedure, the staff will be happy to answer them.

References

The Royal College of Radiologists (2015) Standards for intravascular contrast administration to adult patients. Third edition. London BFCR(15)1

National Radiological Protection Board (NRPB) (2014) Guidance Exposure to ionising radiation from medical imaging: safety advice. [Accessed September 2020]

How to contact us

Brunel building
Southmead Hospital
Westbury-on-trym
Bristol
BS10 5NB

If you have any queries please contact the number on your appointment letter.

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.