Have you been suffering from back pain for a while? You may have already seen a doctor and had tests like an X-ray, a CT scan, or an MRI scan. But sometimes, even these tests can't pinpoint the exact cause of your pain. In such cases, your doctor may recommend a special test that can look into the matter a little more deeply. That's what we're going to talk about in this article today. It's called a myelogram .
Simply put, what is a myelogram?
Think of it this way: a regular X-ray is like a black-and-white photo of our bones. It shows things like fractures and breaks in the bones very clearly. But it doesn't show very delicate things like the nerves and spinal cord inside the spine clearly.
A myelogram is a procedure that makes these subtle details more visible. A special dye, or contrast material, is used to do this. When this dye is injected into the spinal cord, it glows white on an X-ray or CT scan. Just like shining a flashlight into a dark room, this dye allows the doctor to see everything inside the spinal cord, including the spinal cord, the pathways of the nerves, and the connections between the vertebrae.
During this test, the doctor can watch the dye move through your spine live on a screen, like a video. This method is called fluoroscopy .
You may have heard a doctor say things like 'cervical myelogram' or 'lumbar myelogram'. Don't be alarmed by that. They're not two different tests. They just refer to where in your spine the test is being done. For example, if the part of your neck (cervical spine) is being tested, it's a 'cervical myelogram'. If the part of your lower back (lumbar spine) is being tested, it's a 'lumbar myelogram'.
Why would a doctor order a myelogram?
Usually, when you have back pain, a doctor will first recommend a CT scan or an MRI scan. In most cases, these tests can help determine the cause. However, if neither of those tests is conclusive, a myelogram is often ordered to find out more.
This test is especially helpful in identifying the following conditions.
| Medical condition | A simple explanation |
|---|---|
| Herniated disk | A herniated disc is a condition in which the jelly-like part of the spine between two vertebrae bulges out and presses on the nerves. This is a condition that affects many people. |
| Arthritis in spinal joints | With age or due to other reasons, the joints between the spine wear out, become swollen, and become painful. |
| Spinal stenosis | The 'tube'-like part of the spine through which the spinal cord and nerves travel narrows, compressing the nerves. |
| Bone spurs / Osteophytes | In addition to the vertebrae, small bone fragments form, which rub against the nerves, causing pain. |
| Spinal tumors | Cancerous or non-cancerous tumors that form along the spine and put pressure on nerves. |
Additionally, if you have recently undergone back surgery and have developed new pain or numbness in your legs, your doctor may recommend a myelogram to find the cause.
How should I prepare before a myelogram?
Your doctor will give you a clear set of instructions about what you need to do before this test. But in general, let's look at how you should prepare. Following these steps exactly is very important for the success of the test, right?
| What to do | Important points |
|---|---|
| Prepare a vehicle. | You will not be able to drive alone after the test because you may be given a sedative to put you to sleep. Therefore, you may need to call a friend or family member to drive you home. |
| Drink plenty of water. | Starting the day before the test, start drinking about a glass of water (4-8 ounces) every two hours. It is important to prevent dehydration. |
| Fasting | Do not eat any solid food for six hours before the test. |
| Liquid drinks | You can drink clear fluids up to six hours before the test. Examples include water, tea without milk/cream, black coffee, clear soda, unsweetened fruit juice, and soup broth. |
| If you have diabetes: | |
| Insulin | Take your usual insulin dose, but talk to your doctor about this first. |
| Awareness | Remind the staff that you are diabetic as soon as you go to the hospital for the test. |
Usually, blood tests are not required before this test. However, if you have a blood condition, such as dehydration or chronic kidney disease (CKD), your doctor may order the necessary tests.
What happens during the test?
You will not be completely unconscious during this time, but you may be given medication to help you relax. A radiologist and technologist will be in the room with you throughout the test, so there is no need to be afraid.
Here is a step-by-step breakdown of what happens during the test:
1. Preparation: First, you will be laid down on an examination table, either on your stomach or on your side.
2. Cleaning: Your lower back will be thoroughly cleaned with an antiseptic solution.
3. Numbness: Next, a small amount of local anesthesia is injected to numb the area where the needle is inserted, so that you don't feel any pain.
4. Injecting the dye: Now is the most important part. The radiologist will carefully inject a special dye (contrast material) into the fluid-filled sac around your spinal cord. You may feel a slight pinch at this point.
5. Bed tilt: To help the dye flow to the right place in your spine, the examiner will tilt the bed you are on a little. You may also be asked to turn your head slightly.
6. Taking pictures: After the dye has reached the correct locations, a series of X-ray and CT scan pictures are taken.
The entire process usually takes about an hour. There may be some discomfort or a slight headache.
What happens after the test? How long does it take to recover?
After the test is complete, you will be kept under observation in the hospital for about an hour. You will be allowed to go home only after it is confirmed that everything is fine. You will be given a set of written instructions to follow after you go home. The radiologist will send the test report to your primary care physician (PCP).
You will usually be back to normal within 24 hours. Resting during this time is very important because it can reduce the risk of brain and spinal fluid (CSF) leakage. You can return to normal activities after a day.
Be sure to do these things while recovering at home:
- Keep your head elevated: Keep your head elevated above the rest of your body as much as possible. Use two or three pillows when lying down.
- Lie flat on your back: Try to lie flat on your back in bed as much as possible.
- Drink plenty of fluids: Drink plenty of water and other fluids. This will help flush the dye out of your body and reduce headaches. But avoid alcohol.
- Avoid lifting weights: Do not lift any weights or do any strenuous exercise for a day or two.
- Headache remedies: If you have a headache, you can ask your doctor about taking a painkiller like paracetamol. Also, drinking beverages containing caffeine (coffee, tea) can sometimes help relieve headaches.
Side effects and when to talk to your doctor
About 10% of people who have a myelogram may experience minor side effects. These usually go away completely within a day or two. However, it's important to know what's normal and what's serious.
| Type of side effect | Characteristics |
|---|---|
| Side effects that are common and go away in a day or two | |
| Headache | This is the most common side effect. |
| Nausea and vomiting | Some people may experience nausea or vomiting. |
| Serious symptoms that should be reported to your doctor immediately | |
| Persistent headache | A severe headache that cannot be controlled with ordinary painkillers or rest. |
| Fever | Body temperature above 101 Fahrenheit (38.3 Celsius). |
| Stiff neck | Neck stiffness and pain that makes it impossible to bend. |
| Numbness/swelling in the legs | Numbness, burning, or a feeling of lifelessness in the legs. |
| Other features | Fluid or pain from the needle site, difficulty urinating, fainting. |
If you experience any of these serious symptoms, don't delay. Call your doctor immediately or go to the Emergency Department (ETU) of the nearest hospital.
Is this a very painful test?
This doesn't feel the same for everyone. But it's not an unbearably painful test. However, you may experience some minor discomfort.
- You may feel a thud when the die is pierced.
- When the needle is inserted, you may feel an electric shock down your buttock or leg for about a second.
- When the dye enters the body, you may experience a temporary feeling of warmth , a metallic taste in your mouth, or nausea .
Remember, the medical team always tries to make you as comfortable as possible and complete the examination as quickly as possible.
Finally, a myelogram is a valuable tool for finding the exact cause of a back pain that has been bothering you for a long time and that has not been detected by regular tests. With the clear information it provides, your doctor can start the treatment plan that is right for you. So, if a doctor recommends this test, don't be afraid to go ahead and get the facts.
Take-Home Message
- A myelogram is an imaging test that uses a special dye to produce very clear images of the spinal cord and its associated nerves.
- This test is usually recommended when the cause of back pain cannot be clearly identified with CT or MRI scans.
- It is very important to strictly follow the doctor's instructions before the test (fasting, drinking fluids) and after the test (resting, avoiding heavy exercise).
- Although minor side effects such as headache and nausea are common, notify your doctor immediately if you experience serious symptoms such as high fever, stiff neck, or numbness in your legs.
- If you have any concerns or fears about the test, discuss them openly with your doctor.
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