Radiology Procedure (Myelography )

                     (MYELOGRAPHY)

Myelography (or Myelogram) is a radiologic procedure used to evaluate the spinal cord, nerve roots, and subarachnoid space. It involves the injection of a contrast medium into the subarachnoid space using fluoroscopic guidance. This procedure helps detect abnormalities that may not be seen on standard X-rays or when MRI is contraindicated.


✅ Indications:

Myelography is typically used when MRI is contraindicated or needs additional clarification. Common indications include:

  1. Herniated intervertebral disc
  2. Spinal stenosis
  3. Spinal tumors (intradural, extramedullary or intramedullary)
  4. Spinal cord compression
  5. Congenital anomalies
  6. Postoperative evaluation of spine
  7. CSF leak (e.g., spontaneous intracranial hypotension)
  8. Trauma to spinal cord or nerve roots

ðŸšŦ Contraindications:

  1. Allergy to iodinated contrast media
  2. Increased intracranial pressure (risk of brain herniation)
  3. Infection at the puncture site
  4. Coagulopathy or anticoagulant therapy
  5. Seizure disorders not under control
  6. Pregnancy (relative contraindication)

🧑‍⚕️ Patient Preparation:

  1. Informed consent must be obtained.
  2. NPO (nothing by mouth) for 4–6 hours before the procedure.
  3. Allergies to iodine or contrast media must be checked.
  4. Hydration encouraged (if allowed).
  5. Sedation or anti-anxiety medications may be given.
  6. Stop anticoagulants (if advised by physician).
  7. Empty bladder prior to procedure.

💉 Contrast Media Used:

  • Non-ionic, water-soluble iodine-based contrast (e.g., Iohexol, Iopamidol)
  • Dosage depends on patient age and spinal region.

🔍 Method / Procedure:

  1. Patient is placed in prone or lateral decubitus position.
  2. Aseptic technique is used to access the lumbar subarachnoid space (usually L3–L4 or L4–L5) via lumbar puncture.
  3. CSF may be collected for analysis before injecting contrast.
  4. Contrast is slowly injected under fluoroscopic guidance.
  5. Table may be tilted (Trendelenburg or reverse) to allow contrast flow cranially.
  6. Dynamic fluoroscopy and spot radiographs are used to monitor contrast spread.

ðŸ“ļ Films/Imaging Taken:

  1. Conventional X-rays (AP, lateral, oblique)
  2. CT myelography – often follows the contrast injection to provide detailed images.
  3. Fluoroscopy – during contrast administration for real-time visualization.

ðŸĐđ Aftercare:

  1. Monitor for signs of adverse reaction (e.g., headache, nausea, seizures).
  2. Flat bed rest for 4–6 hours (to reduce risk of CSF leak and headache).
  3. Hydration encouraged to help excrete contrast.
  4. Watch for signs of infection or neurological symptoms.
  5. Analgesics for headache, if needed.

ðŸĶī Diseases Diagnosed via Myelography:

  • Disc herniation
  • Spinal cord tumors (meningiomas, neurofibromas)
  • Spinal stenosis
  • Arachnoiditis
  • Spinal cord compression
  • CSF fistula/leak
  • Congenital anomalies (e.g., tethered cord)


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