Steven Sayers and Tina Dolan

Hocking College

RAT 218

February 12, 2008

Myelography is a radiographic study in which the spinal cord and subarachnoid space are viewed and radiographed after the introduction of contrast medium.(Torres, Norcutt, Dutton, 2003, p. 368) This procedure can be used for the cervical, thoracic, or lumbar spinal areas and is done when a patient displays symptoms of herniated nucleus pulpous, tumors, cysts, lesions in the spinal cord or possible bone fragments.(Bontrager & Lampignano, 2005 p. 762) While most people are able to handle the exam, some contraindications for this exam are blood in the cerebrospinal fluid, arachnoiditis, and increased intracranial pressure.(Bontrager & Lampignano, 2005 p. 762)

Patients have special preparations they must adhere to in order to have this procedure done and if they have not properly completed the preparations for the exam it could be cancelled. Performed in a fluoroscopic room to make use of the tilting table which allows the patient to be moved as needed.(Bontrager & Lampignano, 2005, p. 762) A myelography tray is used for this procedure and is filled with a variety of different equipment. And iodinated, water soluble contrast is the contrast media of choice for this exam.(Torres et. al, 2003, p. 369)

Depending on the spinal location of the procedure, the patient could be placed in a variety of positions. For most most varieties of myelograms the patient is placed in the prone position for needle placement but the location of contrast introduction varies. (Torres et. al, 2003, p. 369) For the cervical spine the puncture spot is located at the C1-C2 area.(Bontrager & Lampignano, 2005, p. 763) The lumbar spine puncture spot is the L3-L4 area.(Bontrager & Lampignano, 2005, p. 763) The needle is inserted into the subarachnoid space and then the contrast is injected intrathecally.(Bontrager & Lampignano, 2005, p. 763)

The radiologist will monitor the needle insertion and introduce the contrast flow while watching with the fluoroscope. Once complete, he will take fluoroscopic pictures of the area of interest. The radiologic technologist will operate the fluoroscopic equipment for the radiologist and assist as needed with the spinal introduction. They will position the equipment so that the radiologist will get the appropriate films that he or she needs to evaluate the patient.

Once the exam is complete the radiologist will remove the needle from the patient’s spine and the technologist will clean the area and place a band-aid over the insertion site. After allowing the patient a couple of minutes to rest and gain their composure, the technologist should explain the post exam instructions and attempt to impress upon the patient the importance of following these instructions. This is necessary in order to limit preventable adverse effects.

The patient is required to be on bed rest for 8 to 10 hours.(Torres, et. al, 2003, p. 369) Also, they should have their head elevated at a 35 to 45 degree angle. (Torres, et. al, 2003, p. 369). They will need to drink plenty of fluids.(Torres, et. al, 2003, p. 369) In some instances the patient would need to be positioned with their head lower than their body for approximately 48 hours to prevent headaches.(Torres, et. al, 2003, p. 369) If the patient has any type of complications after the examination they should contact their physician.(Torres, et. al, 2003, p. 369)

Overall, myelography is a useful exam to help detect pathologies of the spine. There are benefits to having this exam, but there are also risks associated with it. For the most part it has been and continues to be replaced by non-invasive studies using MRI or CT. This is because these modalities offer less risk to the patient and provide better quality images. Knowing that, one can see that it will eventually be a non existent examination; however, until then it is imperative that technologists be competent in the performance of myelography.

WORKS CITED

Bontrager, K. L., & Lampignano, J.P. (2005).

Textbook of Radiographic Positioning and Related Anatomy.

St. Louis: Mosby Inc.

Torres, L.S., Norcutt, T.A., Dutton, A.G. (2003).

Basic Medical Techniques and Patient Care in Imaging Technology.

Baltimore: Lippincott Williams & Wilkins.

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