Name of the Procedure:

Myelography, lumbosacral, radiological supervision and interpretation

Summary

Myelography is a diagnostic imaging procedure used to assess the spine, particularly the lumbosacral region. It involves injecting a contrast dye into the spinal canal to provide detailed X-ray images of the spinal cord, nerve roots, and surrounding structures. The procedure helps in diagnosing spine conditions and is closely monitored and interpreted by a radiologist.

Purpose

Myelography is used to diagnose issues affecting the spinal cord, nerve roots, and other structures within the spinal canal, such as herniated discs, tumors, spinal stenosis, and spinal infections. The goal is to obtain clear images to guide appropriate treatment decisions.

Indications

• Persistent lower back pain or sciatica that is not explained by other imaging tests
• Symptoms suggestive of spinal stenosis
• Suspected spinal cord or nerve root tumors
• Evaluation of spinal infections
• Assessment of the spine before spinal surgery

Preparation

• Patients may be instructed to fast for a few hours before the procedure.
• Medication adjustments may be needed, especially if taking blood thinners.
• Pre-procedure blood tests might be required to check kidney function and blood clotting.
• An informed consent form must be signed.

Procedure Description

1. The patient will lie on an X-ray table.
2. The area around the lower back will be cleaned and sterilized.
3. A local anesthetic will be administered to numb the area.
4. A needle is inserted into the spinal canal in the lumbosacral region.
5. Contrast dye is injected through the needle into the spinal fluid.
6. X-ray or CT images are taken to capture detailed views of the spine.
7. The needle is removed, and the injection site is bandaged.

Duration

The procedure typically takes about 30 to 60 minutes, but additional time may be needed for post-procedure monitoring.

Setting

Myelography is usually performed in a hospital's radiology department or an outpatient imaging center.

Personnel

• Radiologist to perform and interpret the imaging
• Radiologic technologist to assist with imaging
• Nurse to provide patient care and monitoring
• Anesthesiologist, if sedation is needed

Risks and Complications

• Headache
• Infection at the injection site
• Allergic reaction to the contrast dye
• Bleeding or hematoma at the injection site
• Nerve damage (rare)

Benefits

• Detailed images of the spine that cannot be achieved with other imaging techniques alone.
• Accurate diagnosis of spinal conditions.
• Informative imaging to guide treatment decisions.

Recovery

• Patients are usually observed for a few hours post-procedure.
• Lie flat for a few hours to minimize the risk of headache.
• Drink plenty of fluids to help flush out the contrast dye.
• Avoid strenuous activities for at least 24 hours.
• Follow-up appointments may be necessary to discuss results.

Alternatives

• MRI or CT scan
• Electromyography (EMG)
• Spine ultrasound (specific situations)
• Each alternative has different benefits and limitations, such as MRI being non-invasive but may not provide the same detail for certain conditions.

Patient Experience

During the procedure, patients might feel slight pressure or discomfort at the injection site. Post-procedure headaches are relatively common but usually subside within a day or two. Pain management is typically handled with over-the-counter pain relievers, and comfort measures include lying flat and staying hydrated.