Looking Inside: Myelogram and Modern Medical Imaging
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An Overview
If you’ve ever said, “this is getting on my nerves,” you may be tired or cranky after a long day, but if you’ve said it while undergoing a pain in your neck or your back, you might have a condition caused by spinal compression.
Nerve compression can be caused by bone, disk, scar tissue, tumor, infection, cysts, or other structures. To determine the exact cause of the pain, doctors look inside a patient’s spinal column using several diagnostic imaging tests, including the myelogram.
A myelogram is an imaging test that’s routinely used for evaluating if the vertebrae in the back may be “pinching” the spinal column or if a herniated disk is pressing on spinal nerves. Myelogram testing is especially effective for diagnosing conditions that affect the spinal cord, the spinal canal, spinal nerve roots, and the blood vessels that supply the spinal canal. Using a radiographic contrast material that highlights the issues, a myelogram provides detailed pictures showing the relationship between the spinal cord, the spinal vertebrae, and the intervertebral disks.
A myelogram test, also called myelography, can detect problems that physicians may not see as well with other diagnostic imaging tests like conventional computed tomography (CT) scans or even magnetic resonance imaging (MRI) scans.
Although an MRI is typically the first imaging exam performed when diagnosing and evaluating many spinal conditions, patients with a medical device, like a cardiac pacemaker, are ineligible for an MRI. The powerful magnets in MRI units have caused pacemakers to change their settings and the leads in the device can become superheated. In such cases, myelography and/or a CT scan, in lieu of MRI, is performed to better diagnose spinal abnormalities.
Table of Contents
Preparation
Inform your healthcare provider if you:
Diagnosing
Recovery
Common Side Effects (Usually resolve within 1-2 days):
- Headaches.
- Nausea and vomiting.
- Nerve injury (shooting pain or persistent ache).
- Bleeding or hematoma.
- Prolonged fluid leakage.
- Meningitis.
- Seizures.
- Allergic reaction to the contrast dye.
A Brief History of Diagnostic Imaging
Before Wilhelm Röntgen’s discovery of X-rays revolutionized medical imaging in 1895, magnifying glasses and then microscopes were considered state-of-the art. The first x-ray ever taken was of the hand of his wife, with her wedding ring displayed on her ring finger. The shadowy picture that emerged showed a marked difference in density from bones to tissue. In 1901, Röntgen was awarded the first Nobel Prize in Physics.
Doctors immediately saw the value of looking inside the body, particularly to find foreign objects, like bullets. The only problem was that x-ray equipment was limited and far from the battlefield. It took two-time Nobel laureate Madame Marie Curie to find the solution. She stopped all her research on radium and polonium during World War 1, hiding it away, and decided to join the war effort by saving lives. According to a story in Smithsonian Magazine, “Curie’s solution was to invent the first “radiological car” – a vehicle containing an X-ray machine and photographic darkroom equipment – which could be driven right up to the battlefield where army surgeons could use X-rays to guide their surgeries.”
Medical imaging continued to evolve with the discovery of ultrasound. Dr. George Ludwig was one of the first to use ultrasound imaging to make pictures through sound waves. While researching gallstones, Ludwig used ultrasound to find masses embedded in soft tissue. His analysis of using soundwaves on animal tissue prepared the way for the next ultrasound pioneer, when in 1956 an obstetrician named Ian Donald used diagnostic ultrasound imaging to determine the diameter of a fetus’s head.
Throughout its 90-year history, the myelogram has involved the injection of a radiocontrast agent followed by several X-ray projections. In 1919, an American neurosurgeon named Dr. Walter Dandy first proposed the concept of using a contrast agent to better look inside the spinal canal. The procedure is called Fluoroscopy. This radiographic contrast gives clinicians a clear picture – a delineation – of tissues that have a similar radiodensity. In 1976, CT myelography, also termed a myelo-CT, was first performed.
According to the American Journal of Neuroradiology, “although radiography of the spine began shortly after Roentgen’s discovery in 1895, there was little printed in medical literature about spine imaging until nearly 25 years later with the development of myelography, first by using air as contrast and then a variety of positive contrast agents. By enhancing the radiodensity of a specific tissue or luminal tract, pathophysiology can be observed in real-time and therapeutic interventions can be better guided. “
Patients Ask:
Are Fluoroscopy and Myelograms the Same Thing?
Texas Back Institute Responds: Physicians rely on fluoroscopy to look at many of the body’s systems – be it skeletal, digestive, urinary, respiratory, or reproductive. Fluoroscopy is a diagnostic study of moving body structures. A myelogram is a type of fluoroscopy that lets spine specialists see the contrast material moving through the spinal column in real-time. Like an x-ray “movie,” it shows dynamic images of what’s going on inside the body. A continuous x-ray beam transmits high-contrast real-time pictures to a monitor, so that the spinal column and its motion can be viewed in detail.
I’m Ready for My Test: Myelogram Procedure
Before the procedure begins, a contrast dye is injected into the spinal column, typically at the lumbar spine, or low back, because it’s easily accessible. A numbing agent may be administered. Spinal nerves are enclosed in a thin covering, or sac called the dura. After the doctor injects a contrast dye inside the dura, the material can then be seen on x-rays. The doctor can view the spinal cord, the subarachnoid space, and other nearby structures more clearly than with standard x-rays. A doctor may use a CT scan while doing a myelogram. This is called CT myelography. If there is tissue altering the flow of the dye into the regions where it normally spreads, this may indicate that nerve tissue is compressed. Myelography is used to evaluate several types of spinal conditions including stenosis or other conditions where nerve root compression is suspected.
Patients Ask:
How Do I Prepare for A Myelogram?
Texas Back Institute Responds: Arrange for a family member or a trusted friend to drive to and from the myelogram because the doctor may prescribe a sedative to help with relaxation. Do not eat any solid foods after midnight prior to a myelogram. Patients may have clear liquids the morning before the test. Dress comfortably in a warm-up suit, sweats, or shorts – you will need to change into a gown. Let the nurse and doctor know if you are pregnant or may be pregnant, are diabetic, have a history of epilepsy or seizure, are allergic to any medication, or have had any reaction to x-ray dye or xylocaine.
Spinal Conditions That Can be Diagnosed with a Myelogram
There are many spine conditions that can be detected with a myelogram. Some of these include:
- Herniated (Bulging) disk: This condition causes nerve compression when the intervertebral disks compress nerves or the spinal cord.
- Arthritis in the Spinal Joints: Degenerative arthritis is caused by “wear and tear” when the cartilage in the spinal joints breaks down, leading to inflammation and pain.
- Bone Spurs (Osteophytes): Bone spurs form in response to tissue damage. When that occurs, the body creates new bone as it attempts to fix the problem. Bone spurs are commonly associated with conditions like arthritis that damages the cushioning between joints.
- Spinal Tumors: Myelograms help identify affecting the spinal cord and nerves within the spinal canal.
Patients Ask:
Are there any conditions where a myelogram is the preferred diagnostic test?
Texas Back Institute Responds: In addition to the fact that MRIs aren’t safe for some patients, like those with a cardiac pacemaker, myelograms may perform better than MRIs in examining some areas of the body. A myelogram provides a detailed view of the spinal cord, making it particularly useful for diagnosing and assessing spinal stenosis (the narrowing of the spinal canal) by locating nerve root compression and capturing the width of the spinal canal and the foramina.
If a patient is recovering from recent spinal surgery and experiences new symptoms like pain or weakness, a myelogram might be necessary to assess the surgical site. Myelograms are often used for diagnosing cases of cervical root avulsion, a severe form of nerve root injury characterized by a complete tear of one or more of the spinal nerve roots, usually due to a high impact traumatic injury.
Is A Myelogram a Safe Procedure?
A myelogram is generally safe and well tolerated by patients. However, as with any medical procedure, some people may experience complications or side effects. Only about 10% of people tested will experience a side effect from a myelogram. Normal side effects usually go away in a day or two. These include:
- Headaches
- Nausea and Vomiting
Though rare, potential complications from myelograms could include:
- Nerve Injury
- Bleeding
- Prolonged Fluid Leakage
- Meningitis
- Seizure
- Allergic Reaction to the Contrast Dye
There is a risk of nerve injury due to a lumbar puncture that may be felt as a shooting pain to the buttocks, or down the leg. This may cause a persistent dull ache or resolve over days to weeks.
Patients Ask:
How do I know if I’m a good candidate for a myelogram?
Texas Back Institute Responds: At Texas Back Institute, we encourage patients to ask questions and our doctors will always address any concerns a patient might have. Myelograms are a standard diagnostic procedure with minimal risk involved and are used to assess many spine conditions.
Symptoms of Cervical Nerve Compression
Pain in and around the neck is called cervicalgia. When a person has a compressed nerve in the cervical spine, symptoms may be:
- Pain and Stiffness: Pain may be experienced in the neck, upper back, or lower back.
- Burning Pain: A burning pain that may spread into the arms, buttocks, or down the legs (sciatica). The sciatic nerve is the dominant nerve that innervates the lower back and extremities.
- Numbness or Weakness: Numbness, tingling, or cramping may occur in the arms, hands, or legs.
- Issues with Coordination: Fine motor skills, like buttoning a shirt or handwriting, may be affected.
- Changes in Gait: Walking patterns, or gait, may be altered.
- Loss of Feeling: Loss of feeling in the feet
- Cauda Equina Syndrome: Serious symptoms include loss of bowel or bladder control, saddle anesthesia (numbness in the legs), and weakness in the legs. Symptoms of Cauda Equina Syndrome require immediate medical attention.
Symptoms of Lumbar Nerve Compression
Pain in and around the low back can be the result of various causes, including muscle strains, arthritis, structural issues, or disk injuries. Symptoms of a compressed lumbar nerve include:
- Pain
- Numbness
- Paresthesia (pins and needles sensation)
- Weakness
- Muscle spasms
- Reflex loss
- Tingling
Patients Ask:
Why would a compressed nerve in my neck cause pain in my legs?
Texas Back Institute Responds: Cervical radiculopathy, commonly called a “pinched nerve” can sometimes cause referred pain, pain that originates in the neck region but travels along nerve pathways to another location. However, leg pain is more commonly the result of issues in the lumbar spine (low back). This is why the spine specialists at Texas Back Institute use diagnostic imaging like myelograms to pinpoint the exact location of spine conditions for treatment.
What’s On the Horizon in Diagnostic Imaging?
What does the future hold? Many promising advances in diagnostic imaging could be the result of artificial intelligence, or AI. When it comes to looking inside the body, the better the real-time diagnostic image, the more precise the therapeutic intervention. Medical AI technology is growing at a rapid clip, and “imaging is leading the way,” said Stanford University radiologist Curtis Langlotz at The New Wave of AI in Healthcare symposium in New York City in May.
A recent BBC article reported on a study of the accuracy of an AI software, X-Raydar, in its diagnostic analyses of the chest X-rays of more than 1.5 million people with 37 different conditions. As the study continued, AI began to note that some of the conditions it was scanning for were more serious and began to red flag these.
Will machine learning replace physicians in practicing the art of medicine? That’s not likely to happen. Empathy, context, and intuition are key to making diagnostic assessments and AI machine learning cannot replicate these purely human attributes. Diagnosis requires a nuanced interpretation that’s challenging for AI. Instead, what AI can do is be a valuable part of the doctor’s black medical bag. By saving time and speeding up the process, AI can augment what the doctor needs to know to diagnose and recommend treatment.
Why Wait?
At the Texas Back Institute, our family of physicians work to bring the best possible outcome for you and your family. If you are experiencing pain and are ready to get your life back, click here to schedule an evaluation.
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Frequently Asked Questions
Physicians rely on fluoroscopy to look at many of the body’s systems – be it skeletal, digestive, urinary, respiratory, or reproductive. Fluoroscopy is a diagnostic study of moving body structures. A myelogram is a type of fluoroscopy that lets spine specialists see the contrast material moving through the spinal column in real-time. Like an x-ray “movie,” it shows dynamic images of what’s going on inside the body. A continuous x-ray beam transmits high-contrast real-time pictures to a monitor, so that the spinal column and its motion can be viewed in detail.
Arrange for a family member or a trusted friend to drive to and from the myelogram because the doctor may prescribe a sedative to help with relaxation. Do not eat any solid foods after midnight prior to a myelogram. Patients may have clear liquids the morning before the test. Dress comfortably in a warm-up suit, sweats, or shorts – you will need to change into a gown. Let the nurse and doctor know if you are pregnant or may be pregnant, are diabetic, have a history of epilepsy or seizure, are allergic to any medication, or have had any reaction to x-ray dye or xylocaine.
In addition to the fact that MRIs aren’t safe for some patients, like those with a cardiac pacemaker, myelograms may perform better than MRIs in examining some areas of the body. A myelogram provides a detailed view of the spinal cord, making it particularly useful for diagnosing and assessing spinal stenosis (the narrowing of the spinal canal) by locating nerve root compression and capturing the width of the spinal canal and the foramina.
If a patient is recovering from recent spinal surgery and experiences new symptoms like pain or weakness, a myelogram might be necessary to assess the surgical site. Myelograms are often used for diagnosing cases of cervical root avulsion, a severe form of nerve root injury characterized by a complete tear of one or more of the spinal nerve roots, usually due to a high impact traumatic injury.
At Texas Back Institute, we encourage patients to ask questions and our doctors will always address any concerns a patient might have. Myelograms are a standard diagnostic procedure with minimal risk involved and are used to assess many spine conditions.
Cervical radiculopathy, commonly called a “pinched nerve” can sometimes cause referred pain, pain that originates in the neck region but travels along nerve pathways to another location. However, leg pain is more commonly the result of issues in the lumbar spine (low back). This is why the spine specialists at Texas Back Institute use diagnostic imaging like myelograms to pinpoint the exact location of spine conditions for treatment.
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