Myelogram

WHAT YOU SHOULD KNOW:

• Myelogram, also called myelography (mie-LOG-rah-fe), is an x-ray procedure to examine the spinal canal. This is done using a contrast material (dye). The spinal canal contains the spinal cord, which carries messages between your brain and your body, and cerebrospinal fluid (CSF). CSF is a clear fluid that also flows around the brain. The spine is formed of vertebrae (small bones) that are stacked on one another with soft discs in between bones. Myelogram is usually done to diagnose a slipped disc, tumor, or problems causing a block in CSF flow. It may be used to check the spine after surgery or in patients with a slow wearing away of the bones. This procedure may not be done if you bleed easily.
  
  
• During a myelogram, dye is injected into the spinal canal and x-ray pictures of the spine are taken. The dye may be made of oil or water. Dye made of water can be absorbed by the body. This helps caregivers see the structures in your spine, such as nerves, spinal cord, discs, and bones better. The dye is usually put in the lower back area. Less often, the dye is given in the neck area of the spine.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

Having a myelogram may put you at risk of having other problems. You may have a bad headache, neck or back pain, nausea (upset stomach), and vomiting (throwing up). There may be bleeding, infection, injury to a disk in your spine, or spinal fluid may leak from the site. Your nerves or spinal cord may be damaged. The dye used during the procedure may cause an allergy. It may reach the brain and cause seizures or brain problems. The dye may also damage the kidneys. Patients who have blood disorders or who are taking certain medicines are at a higher risk for problems. Talk with your caregiver if you are worried or have questions about your procedure, medicine, or care.

WHILE YOU ARE HERE:

Before your procedure:

• Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Gown: A hospital gown is used so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. When you feel better you may be able to wear your own gown or pajamas.
  
  
• An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Local anesthesia: This is medicine to make you comfortable during your procedure. It is a shot of medicine put into the skin. It is used to numb the area and dull your pain. You may still feel pressure or pushing during the procedure.

During your procedure:

• You may see large x-ray machines and other equipment inside the room. X-rays with a TV screen is used to guide caregivers during the procedure. Your skin on your back is cleaned with a special cleanser. Your caregiver looks for the best place to insert the needle where the problem in the spine can be seen better. You are given one or more shots of numbing medicine under the skin where the dye will be injected.
  
  
• A needle is inserted between the bones of the spine in your back. The needle is inserted further until it reaches the spinal canal and CSF flows out. A small amount of dye is injected to check if the needle is in the right place. When your caregiver is sure of the needle's position, more dye will be injected slowly. The needle may then be taken out or left in place, depending on the type of dye used. While lying on your stomach, the table is tilted head-up. This allows the dye to move up and down your spine. A series of x-rays are taken.
  
  
• If the neck area of the spine is checked, a pillow is placed under your abdomen (stomach). A pad is also put under your chin. If the chest area is checked, you are placed on your side with head raised and bent sideward on a high pillow. These help the dye flow up while preventing it from moving to the head. The table is tilted slightly head-down. Once the dye collects in the neck or chest area, the table is returned to a straight position. Your caregiver turns you carefully so that you lie on your back and a series of x-rays are then taken. When the procedure is finished, the dye is removed if it is made with oil and the injection site is covered with a bandage.

After your procedure:

You may need to lie flat in bed or with your head slightly raised. Do not get out of bed until your caregiver says it is OK. Caregivers will keep a close watch on you. When caregivers see that you are OK, you may be allowed to go home. If caregivers want you to stay in the hospital, you will be taken back to your hospital room. Tell a caregiver if you have a headache, back or neck pain, or tingling, numbness, or weakness below your waist.

• Drinking liquids: You may be asked to drink more liquid than usual after the procedure. For most people, good liquids to drink include water, milk, and juices. Do not drink alcohol. Tell your caregiver if you cannot drink a lot of liquid because of another medical condition, such as a heart or kidney condition.
  
  
• Monitoring:
  
  
  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
    
    
  • Neurologic exam: This is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show caregivers how well your brain works after an injury or illness. Caregivers will check how your pupils (black dots in the center of each eye) react to light. They may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.
  
  
• Post-procedure headache: You may develop a headache during the first few hours after your procedure, which may last up to several days. This commonly happens when the CSF leaks from the site of injection. The headache may range from mild to severe (very bad) and may get worse when you sit or stand. You may have neck and back pains as well. If your headache does not go away due to continuous leakage of CSF, a blood patch procedure may be needed. This procedure uses a small amount of your blood that is put into your spinal canal to seal the leak.