Myelography via lumbar injection, including radiological supervision and interpretation; cervical
CPT4 code
Name of the Procedure:
Myelography via Lumbar Injection, including Radiological Supervision and Interpretation; Cervical
Summary
Myelography is a specialized imaging procedure used to examine the spinal cord, nerve roots, and surrounding structures. During the procedure, a contrast dye is injected into the spinal canal via a lumbar puncture (lower back) to make these areas more visible on X-rays or CT scans. This specific description focuses on evaluating the cervical spine (neck region).
Purpose
Myelography is performed to diagnose conditions affecting the spinal cord, nerve roots, and other spinal structures. It is particularly useful for identifying spinal stenosis, herniated discs, tumors, infections, and inflammatory diseases.
Indications
- Persistent neck, arm, or shoulder pain unresponsive to conservative treatments
- Symptoms suggesting nerve root compression, such as radiating pain, numbness, or weakness
- Previous inconclusive imaging studies
- Preoperative assessment for spinal surgery
- Suspected spinal tumors, infections, or inflammatory diseases
Preparation
- Patients may be instructed to fast for several hours before the procedure.
- Certain medications, especially blood thinners, might need to be adjusted.
- A pre-procedural assessment, including a complete medical history and possible blood tests, will be performed.
- Arrangements for transportation home post-procedure, as sedation impacts driving ability.
Procedure Description
- The patient lies face down on a padded table.
- Local anesthesia is administered to numb the lumbar puncture site.
- A needle is carefully inserted into the spinal canal in the lower back.
- A contrast dye is injected through the needle into the cerebrospinal fluid.
- The patient may be repositioned to help distribute the dye, ensuring optimal imaging of the cervical spine.
- X-rays or CT scans are taken to visualize the cervical spinal cord and nerve roots.
- The needle is removed, and a small bandage is applied to the injection site.
Tools and Equipment:
- Spinal needle
- Contrast dye
- X-ray or CT scanner Anesthesia:
- Local anesthesia, with optional mild sedation
Duration
The procedure typically takes 30 to 60 minutes.
Setting
Myelography is usually performed in a hospital radiology department or an outpatient imaging center.
Personnel
- Radiologist
- Radiologic technologist
- Nurse
- Sometimes an anesthesiologist if sedation is used
Risks and Complications
- Headache
- Infection at the injection site
- Bleeding or hematoma formation
- Allergic reaction to the contrast dye
- Nerve injury or spinal cord damage (rare)
- CSF leak, which may cause persistent headaches
Benefits
- Provides detailed images of the spinal cord and nerve roots.
- Aids in accurate diagnosis and treatment planning.
- Non-surgical, minimally invasive procedure.
Recovery
- Patients are usually observed for a few hours post-procedure.
- Mild pain or discomfort at the injection site is common.
- Increase fluid intake to help flush out the contrast dye.
- Avoid strenuous activities for 24-48 hours.
- Follow-up appointments may be needed to discuss the results.
Alternatives
- MRI or CT scan without myelography
- Epidural steroid injections for pain management
- Physical therapy or conservative treatments
- Spinal surgery, if conservative treatments fail
Patient Experience
During the procedure, patients might feel brief discomfort from the needle insertion and pressure from the contrast dye. Post-procedure, a headache or mild backache could occur, manageable with over-the-counter pain medication and rest. Comfort measures include a relaxed environment and reassurance from the medical team.