Norm of Myelogram
Normal cervical, lumbar, or thoracic myelogram. Normal spinal subarachnoid space with no obstructions.
Usage of Myelogram
Arachnoiditis, back pain, disk rupture, spinal problems, accidental injury, tumors of the spine, degenerative disease of the spine, nerve plexus lesions, cancer metastasis to the spine.
Description of Myelogram
Myelography is a radiographic study of the spinal cord and nerve roots by using contrast dye, contrast oil, or air injected by way of spinal needle into the spinal subarachnoid space. Myelography use is declining because magnetic resonance imaging (MRI) can usually match the findings of myelography with less risk to the client. Myelography is more often reserved for conditions that cannot be evaluated via MRI or CT, such as weight-bearing flexion and extension views, or walking views. Use of oil contrast has the disadvantage of tissue irritation and poor absorption by the subarachnoid spaces. Air contrast may be used instead of oil, but in this case, tomography is essential to improve visualization.
Professional Considerations of Myelogram
Consent form IS required.
Allergic reaction to dye (itching, hives, rash, tight feeling in the throat, shortness of breath, bronchospasm, anaphylaxis, death); contrast-induced renal failure; intramedullary cord injection. Multiple sclerosis may be worsened by this procedure.
Previous allergy to dye, iodine, or shellfish; renal insufficiency; bleeding abnormalities or clients receiving anticoagulants; increased intracranial pressure; low back pain; spinal deformities; infections near the puncture site; pregnancy (because of radioactive iodine crossing the blood-placental barrier).
- Sedation or narcotic analgesia should be considered before this procedure.
- Shave the lumbar area if necessary.
- Obtain a lumbar puncture tray, sterile drapes, 1%–2% lidocaine (Xylocaine), iodized Pantopaque oil or water-soluble iodine metrizamide contrast medium, antiseptic, and sterile gauze.
- If metrizamide is to be used as a contrast dye, discontinue the use of phenothiazines 48 hours before the procedure.
- Obtain baseline vital signs.
- Have emergency equipment readily available.
- If increased intracranial pressure is suspected, a CT of the brain should be performed before lumbar puncture to rule out this condition.
- See Client and Family Teaching.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- The client is positioned on the side with the knees drawn up toward the abdomen and the chin on the chest for the lumbar puncture.
- The lumbar puncture is verified by fluoroscopy.
- Spinal fluid is generally obtained for analysis.
- 5–15 mL of iodized Pantopaque oil dye or water-soluble iodine metrizamide contrast is injected into the subarachnoid space in the lumbar area or into the cisterna magna.
- The client is tilted to maneuver oil up and down the spine.
- Radiographic films are taken.
- Oil is removed by aspiration after the procedure.
- Cleanse the puncture site with antiseptic and cover with a dry, sterile dressing.
- See Lumbar puncture.
- Do not administer phenothiazines for nausea or vomiting if water-soluble contrast was used.
- Results are normally available within 48 hours.
Client and Family Teaching
- The client should fast from food and fluids for 4–8 hours before the procedure.
- The procedure takes 1 hour.
- Review activity limitations.
- Drink 6–8 glasses of water or other fluids each day for 2 days (when not contraindicated) to hasten removal of any contrast medium.
- Potential side effects or complications include arachnoiditis, headache, nausea and vomiting, seizures, spinal infection, subarachnoid bleeding, and tingling at the puncture site.
- Observe the puncture site for bleeding, hematoma, or swelling for 24–48 hours after the procedure.
- A mild analgesic may be required for pain control.
- Monitor the lumbar puncture site for signs and symptoms of infection until the site is healed.
Factors That Affect Results
- Conditions such as convulsions, pain, stiffness of the neck, and stupor may interfere with the procedure.
- Severe kyphosis or scoliosis may prohibit completion of this procedure.
- Dye usage affects preparation and postprocedure care.