Thoracic myelogram
Myelography is a technique that visualizes the spinal canal after injection of a contrast agent (dye).The dye is typically introduced into the spinal canal via a lumbar puncture and can be moved into the thoracic spine by “tipping the patient” head down while secured on the myelography table. Multiple x-rays and a CT scan provide valuable diagnostic information and are complementary to MRI scans.
Pre-procedure instructions
An NMH nurse will contact you prior to your procedure date to discuss the following:- Confirm your appointment date and time
- Inform you of your arrival time and parking instructions
- Prior imaging: please bring any prior spine imaging including film, CD and reports. Prior imaging includes CT, MRI and X-Ray.
- Current medications, especially blood thinners
- Allergies
- Your questions
Hospital arrival
Arrive on-time or better yet, early. If you are driving from a distance or inclement weather is forecasted, please leave extra time for your trip. When you arrive, come to the 4th floor of the Feinberg Pavilion and “check-in” at the desk. You are now in the “waiting room”. Shortly after check-in, a support staff will take you to the “holding room”. In the holding room, you will meet a holding room nurse who will perform a pre-procedure check-list and help you change into a hospital gown. A physician will then meet with you to discuss your procedure, answer your questions and obtain informed consent.
Team and Quality
Quality, safety and precision guide our practice. Each procedure is staffed by a radiology technologist and a staff physician. A procedure nurse is available if sedation necessary, which is very uncommon. The procedure technologist is responsible for positioning you on the procedure table, obtaining the appropriate instruments, documenting the procedure with imaging and assisting the physician. The staff physician is responsible for knowing your history, performing the procedure and providing you with follow-up instructions.
Procedure
You are brought to the procedure room by the radiology technologist, transferred to the procedure table and sterilely prepped and draped. Before proceeding, a pre-procedure “Time-out” to confirm your identity, the planned procedure and any relevant details such as allergies is performed. This is strictly for your safety. Using sterile technique, universal precautions and local anesthetic, a thin needle is advanced through the skin to the target tissues, typically the lumbar spinal canal. The target tissues are precisely localized by advancing the needle under image guidance (fluoroscopic or CT) and confirmed with free flow of spinal fluid. Only after the location is precisely identified is the contrast dye administered. The needle is removed, skin cleaned and a standard band-aid applied. You will be “tipped” somewhat to move dye into the thoracic spine. You won’t fall onto the ground: your feet are secured to the table.
Post-procedure
You are monitored in the holding room for 4 hours. In our experience, 4 hours in bed markedly reduces the risk of a post-LP headache, which is the most common complication. In the meantime, a CT scan will be performed for diagnostic information.
Follow-up
There are no follow-up requirements in radiology. If you develop a postural headache (severe in the upright position, relieved when lying down), treatment is conservative for 48 hours and includes rest, fluids especially caffeinated fluids and analgesics. If these fail or the headache is too severe, call radiology for a blood patch appointment.
Potential side effects
Postural headache is uncommon occurring in less than 5 % of patients. Of those who develop a post-LP headache, approximately 10% of those will require a blood patch, which can be scheduled same-day. Infection is extremely uncommon. Signs of infection include fever, sweats and neck pain to name a few.