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Medical Disability Advisor  >  Myelography

Myelography


Related Terms


  • Myelogram

Specialists


  • Neurosurgeon
  • Orthopedic (Orthopaedic) Surgeon
  • Radiologist

Comorbid Conditions


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Factors Influencing Duration


The underlying condition necessitating the procedure and the development of any complications will influence the length of disability. Postmyelography headaches may prolong disability by a few days.

Medical Codes


ICD-9-CM:
87.21 - Contrast Myelogram

Definition


Myelography is a special x-ray that allows for visualization of the spinal canal. The procedure outlines the spinal cord, spinal nerve roots, and surrounding membranes (meninges) by using an iodine dye injected into the spinal canal through a needle inserted between vertebrae (lumbar puncture). After the dye is injected, the area is x-rayed. A myelogram may be used to determine the cause of pain, numbness, or weakness in the back, neck, arms, or legs; or the loss of bladder and bowel control. Myelograms are often done in conjunction with computerized tomography (CT scans) for more detailed visualization.

Myelography is not done as frequently as it once was because MRI is now considered the imaging method of choice for visualizing the spinal cord and canal. Myelography is now employed primarily for individuals who cannot undergo MRI, such as those with claustrophobia or a metal implant, or when MRI results are inconclusive.

Source: Medical Disability Advisor



Reason for Procedure


Myelography is used to diagnose conditions such as herniated discs, spinal cord or nerve root compression caused by rough bony protrusions (bone spur), filling defect caused by scar tissue, tumors or cysts, degenerative conditions of the spine, spinal nerve injury, or arteriovenous malformations. It is typically done when surgery is being considered, not only to confirm the diagnosis but also to determine the exact location of the abnormality.

Source: Medical Disability Advisor



How Procedure is Performed


The procedure is done in an outpatient radiology center or in the radiology department of a hospital. With the individual lying down, a needle is inserted between two vertebrae (lumbar puncture). A small amount of cerebrospinal fluid is removed and replaced with an equal volume of dye. The individual's body is positioned to allow the dye to circulate throughout the spinal canal. The movement of the dye is visualized using a machine called a fluoroscope, and appropriate x-ray pictures are taken to reveal an obstruction or other abnormality. If CT pictures will also be taken, several hours typically are allowed to pass before beginning the CT procedure to ensure full circulation and penetration of the dye.

Myelography takes about 1 hour. If a CT scan is also done, more time will be needed. Once the procedure is complete, the individual is instructed to remain quietly in bed for several hours with the head elevated, or up to 24 hours if headache develops. The individual must be closely supervised during this recovery period.

Source: Medical Disability Advisor



Prognosis


Before the CT scan and MRI, myelography was the gold standard for detecting structural abnormalities in individuals with low back pain, numbness, or weakness. It is not, however, sensitive to detecting all abnormalities. CT scan and MRI, unless contraindicated, have now replaced myelography in routine use, because they carry less risk and are less invasive, while producing high-quality results.

Source: Medical Disability Advisor



Complications


The most common complications of myelography include a severe headache (20% of individuals), nausea, and vomiting (Payne). Irritation of the membranes (meningeal irritation) or change in the cerebrospinal fluid pressure after spinal tap may cause the development of a headache; fever; nausea; dizziness; stiff neck, shoulders, or back; and a sensitivity or aversion to light (photophobia). An infection of the membranes (meningitis), herniation of the brain, or seizures may also develop, but rarely. Some individuals may experience a mild to life-threatening allergic reaction to the dye used. In rare cases, anaphylactic shock has been reported.

Source: Medical Disability Advisor



Return to Work (Restrictions / Accommodations)


The individual may need a day or two after the procedure to rest, especially if complications such as headache develop. Additional time may be needed for more serious complications. Lifting is discouraged for 48 hours to permit the puncture to seal, after which normal activity may be resumed.

Source: Medical Disability Advisor



Cited References


Payne, Kattie. "Myelography." WebMD.com. Eds. Youngerman-Cole Sydney and Greer Daniel. 9 Jan. 2004. WebMD Inc. 20 Oct. 2004 <http://www.webmd.com>.

Source: Medical Disability Advisor






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