Myelogram

You are receiving this because the doctor you have seen has sent you for a special X ray test called a Myelogram (CT myelogram). The reasons for this should have been explained to you by the doctor but will be discussed again on the day of the test.

What is a Myelogram/CT Myelogram?

This is a specialist X ray test to look at the spine. It is most often used in patients who cannot have an MRI scan or where alternative test results are unclear. It is sometimes used to look at how spinal fluid flows, or for a leak of spinal fluid. An X ray dye (contrast) is used to make the spinal fluid visible using X rays. This fluid surrounds the nerves of the spine and if there is pressure on them this can usually be seen on a myelogram. X ray pictures are taken using a special X ray camera (fluoroscopy), you will then be taken to a different room for a CT scan which also uses X rays but gets a 3D image of your spine.

Preparation

• There are no special preparations before the procedure.
• If you are on a medication to thin your blood the person who phoned you to arrange your appointment will have discussed this.
  These drugs include o Clopidogrel (Plavix)
  Ticlopidine (Ticlid)
  Warfarin (Coumadin)
  Rivaroxaban (Xarelto)
  Dabigatran (Pradaxa)
  Apixiban (Eliquis)
• You may have been told to stop taking a blood thinning medication before the test.
• You should take all other medication as normal. It is sensible to have a light breakfast and is advisable to drink more fluids than usual in the 12 hours before the examination to reduce the risk of headache.
• This is an X ray technique and uses radiation to obtain the images, you should not have this test if you are (or could be) pregnant.

What happens

• You will be given a bed or chair, usually on Jefferson ward and one of the nurses will check you in, this includes checking blood pressure etc. If you have been on a medication called warfarin a blood sample may be taken to check your blood clotting.
• The doctor who will be performing the test (a radiologist) will come to see you on the ward. They will go through the reason for doing the test, explain what the test involves, inform you of any possible side effects or complications (see below) and answer any questions you may have. If you are happy to go ahead with the test you will be asked to sign a consent form, you can keep a copy of this if you wish.
• If you would rather not get changed into a surgical gown you need to bring with you clothes that have no metal on them (zips etc.) and allow access to your lower back. Pyjamas or “sports” clothes are ideal.
• You will be brought to the X ray department fluoroscopy room and asked to lie on the X ray machine table on your left hand side with your knees slightly bent.
• In order to get the X ray dye into your spinal fluid a fine needle needs to be placed into your back. This is nearly always in the lower back even if it is your neck that is the area of most interest. This is called a lumbar puncture and is usually performed using the X ray machine for guidance and local anaesthesia to make it as quick and comfortable as possible. Usually a small sample of spinal fluid is taken and sent for some routine tests.
• A small amount of X ray dye is then injected, sometimes people get a “hot” or pressure sensation in the upper part of their left leg or the left side of their bottom as this is done. This is because the dye is quite concentrated when it is first injected and it sinks to the left side.
• The dye now needs to be moved to the area of most interest, this may involve tilting the X ray table so that your head is up or down and asking you to turn in different directions, some X ray images will be taken at the same time.
• If the dye is run up to the neck some may get inside your head, this is not dangerous in any way but may give you a headache.
• You will then be asked to move onto a hospital trolley and taken for a CT scan, this will cover the area of spine your doctor is interested in.
• This test takes approximately 45mins.
• Occasionally the doctor will advise you that a second CT will be needed a few hours later but this is not common.

Alternatives

• If you are able to have an MRI scan this will have been done before a myelogram is considered
• A CT scan of the spine can be done without injecting dye into the spinal fluid but it is often not possible to see nerve compression on this.

Side effects

• Most patients have no side effects during a myelogram, the lumbar puncture is however a little uncomfortable. Afterwards some patients do develop a headache, his is usually due to a small internal leak of spinal fluid which causes a “low pressure” headache (improves on lying down). This doesn’t usually last more than 2 or 3 days, simple pain killers such as paracetamol can be taken and caffeine is said to help. The most important thing is to drink plenty of fluids.
• Occasionally if you have leg or arm pain your symptoms get worse for 1 or 2 days after the test but this does not last
• Persisting headache is unusual but does happen and may require treatment with something called a blood patch ? This is an X ray investigation and uses “ionising radiation” this means that you will get a dose of radiation.

Potential Complications

• Nerve root damage
• Meningitis
• Infection in the spine that can damage the nerves causing paralysis
• Blood clot within the spine that can press on the nerves and cause paralysis

We have not seen any cases with these complications at The Walton Centre.

Aftercare

Following the myelogram generally we advise you to sit up for the next few hours, this helps to stop too much dye entering your head causing a headache. Usually you can go home an hour or so after the test; the nurses will check on you and then let you go. We suggest that you do not drive yourself home after the test. You should try and drink more fluids than usual for the next 24-48 hrs.

Results

These will be sent to the doctor who referred you for the myelogram. If you have not heard from the hospital within 3-4 weeks then please call the secretary to the consultant you are under by contacting the hospital switchboard on 0151-529-3611

Should you need any further medical help after returning home please call NHS Direct/your GP/emergency dept. of your local hospital.

Access

This letter can be translated into another language or produced in another format such as Braille or audio. To find out more please contact the Patient Experience Team on 0151 556 3090.