Introduction
A myelogram (or myelography) is a specialized imaging test used to evaluate the spinal cord, nerve roots, and surrounding structures—especially when MRI is not suitable. It combines fluoroscopy (real-time X-ray) with an injection of contrast dye into the subarachnoid space (the area around the spinal cord filled with cerebrospinal fluid)
Definition
Myelography is a radiographic examination that involves the use of a contrast medium to detect pathology of the spinal cord, including the location of a spinal cord injury, cysts, and tumors.
Purposes
- Evaluating spinal tumors, cysts, or infections
- Assessing spinal cord injuries
- Investigating persistent back or leg pain when MRI is contraindicated (e.g., pacemaker patients)
Indications
- Intraspinal abnormalities.
- Nerve root abnormalities.
- Disk prolapse.
- Spondylosis.
- Spinal stenosis.
Contraindications
- Recent myelogram performed within 1 week.
- History of seizures.
- Septicemia.
- Pregnancy.
- Intracranial pressure.
Articles
| Articles | Purpose |
| A trolley containing: | |
| Lumbar puncture needle with stylet | To inject local anesthetic agent, for example, lidocaine. |
| Surgical towel | To create a sterile field. |
| Bowl with cotton balls and gauze pieces | To prepare the site and for dressing. |
| Injection tray containing: | |
| Inj. xylocaine 2% | Acts as local anesthetic. |
| 2-cm³ syringe (2) with 20G and 22G needles | To administer local anesthetic and for repeated aspiration. |
| Alcohol swab | To clean the site. |
| Inj. metrizamide (Amipaque) 440 mg | For contrast medium (as per the order/patient status medium obtained). |
| Inj. iohexol (Omnipaque) 350 mg | For contrast medium (as per the order/patient status medium obtained). |
| Other equipment: | |
| Mackintosh and towel | To protect the bed from soiling and being wet. |
| Sterile masks, gowns, and gloves | To follow aseptic technique. |
| Sterile dressing wet | To cover the punctured site. |
| Antiseptic solution (e.g., povidone-iodine, chlorhexidine) | To keep the aspiration site free of microorganisms and to prevent infection. |
| Tincture benzoin (if necessary) | To control bleeding at the punctured site. |
| Ice pack | To reduce bleeding, tenderness, swelling, and erythema at the puncture site. |
Procedure
| Nursing Action | Rationale | |
| 1. | Explain the procedure to the patient. | To reassure the patient and gain cooperation. |
| 2. | Obtain informed consent. | To avoid ethical and legal issues. |
| 3. | Provide privacy. | To promote comfort. |
| 4. | Wash hands. | To prevent transmission of microorganisms. |
| 5. | Perform neurological examination. | To obtain baseline data for further reference. |
| 6. | Position the patient in side-lying position. | To promote easy insertion of the spinal needle. |
| 7. | Instruct the patient not to move during the procedure. | To prevent injury to the adjacent structures. |
| 8. | Assist the physician in preparing the skin with antiseptic solution. | To minimize risk of contamination. |
| 9. | Perform lumbar puncture. | To inject the contrast dye. |
| 10. | Administer the contrast medium and tilt the table to allow the column of the dye to move up and down within the subarachnoid space. | To facilitate visualization of all structures. |
| 11. | Screen and obtain images at appropriate levels by minimally adjusting the position of the table/patient. | To obtain various films highlighted by the contrast dye for detecting any abnormalities. |
| Aftercare | ||
| 12. | Keep the patient on strict bed rest. | To prevent leakage of CSF from the puncture site. |
| 13. | Position the patient with the head end at 30° elevation. | To prevent increase in ICP. |
| 14. | Monitor the neurological and vital parameters. | To identify and treat early signs of complications. |
| 15. | Encourage more oral fluid intake. | To rehydrate after the procedure. |
| 16. | Provide a light soft diet if the patient does not have any complaints of nausea or vomiting. | To promote easy digestion. |
| 17. | Administer mild analgesics, if pain persists. | To promote comfort. |
| 18. | Check the patient’s ability to void. | To rule out any neurological deficits due to nerve damage. |
| 19. | Observe for fever, stiff neck, photophobia, or any signs of chemical or infectious meningitis. | To identify and treat complications at the earliest. |
| 20. | Document the procedure with date, time, duration, details of contrast medium used, any allergic reactions, and patient’s postprocedural status. | For reporting and further management of care. |
Types
- Cervical Myelography
This procedure is used to look for the level of spinal cord disease or compression of the spinal cord at the neck region for those who are unable or unwilling to undergo MRI scan of the spine.
- Lumbar Myelography
This procedure is used to look for the level of spinal cord disease such as lumbar nerve root compression; lumbar puncture is performed before injecting contrast into the thecal sac. However, it is risky to perform lumbar puncture in patients with raised intracranial pressure.
- Thoracic Myelography
To image the thoracic spine, lumbar puncture is performed, and contrast medium is injected into the puncture site. The patient is instructed to lie down on one side, and then the head of the table is lowered with the patient’s head being supported by a bolster or pad to prevent the contrast from flowing up into the neck.
- CT Myelography
Contrast medium is injected into the thecal sac. The patient is rotated longitudinally a few times to ensure even coating of the contrast around the spinal cord and reduce the possibility of layering of the contrast medium just before the CT scan.
Note: For those who had lumbar puncture performed in 1 week’s time, there may be some cerebrospinal fluid (CSF) accumulated in the subdural space. Thus, the needle may be mistakenly inserted into the subdural space rather than into the targeted subarachnoid space.
General Instructions
- The patient should be prepared physiologically and psychologically.
- Instruct the patient to not drink for 6 hours prior to the procedure.
- Strict aseptic technique should be followed throughout the procedure.
- The client should be informed that the X-ray table may be titled in varying positions during the study.
- The commonly used dyes are metrizamide (Amipaque) and iophendylate (Pantopaque) so the sensitivity should be checked.
- Instruct the client to remain supine for 12-24 hours after the procedure.
- Instruct the client to use one to two pillows on the bed. Instruct him or her not to lie flat or allow his or her head to be lower than the rest of his or her body until the next morning.
- Need for real-time imaging of spinal fluid flow
- Clarifying findings from inconclusive MRI or CT scan
- Presence of metal implants or pacemakers
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
