Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical), radiological supervision and interpretation
CPT4 code
Name of the Procedure:
Myelography, 2 or more regions (e.g., lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical), radiological supervision and interpretation
Summary
Myelography is a specialized imaging procedure used to visualize the spinal cord, nerve roots, and surrounding structures using a contrast dye and X-ray technology. It involves examining two or more regions of the spine, such as lumbar and thoracic, to diagnose or evaluate various spinal conditions.
Purpose
Medical Condition or Problem Addressed
Myelography helps diagnose spinal conditions such as herniated discs, spinal stenosis, tumors, infections, and nerve compression.
Goals or Expected Outcomes
The goal is to obtain detailed images of the spinal cord and nerve roots to aid in accurate diagnosis and guide treatment plans.
Indications
Specific Symptoms or Conditions
- Persistent back or neck pain
- Unresolved leg or arm pain
- Suspected spinal injuries
- Suspected spinal tumors or infections
Patient Criteria
- Patients with MRI contraindications (e.g., those with certain implants)
- Individuals with severe symptoms warranting comprehensive spinal imaging
Preparation
Pre-procedure Instructions
- Fasting for several hours before the procedure
- Temporary discontinuation of certain medications (as advised by a physician)
- Pre-procedure blood tests to check kidney function
Diagnostic Tests
- Basic blood tests to ensure safe administration of contrast dye
- Pre-procedure MRI or CT scan, if applicable
Procedure Description
Initial Preparation:
- The patient is positioned on an X-ray table.
- An IV line is inserted for the administration of medications or sedatives.
Anesthesia:
- Local anesthesia is administered to numb the injection site.
Contrast Dye Injection:
- A thin needle is inserted into the spinal canal, and contrast dye is injected.
Imaging:
- X-ray or fluoroscopy captures real-time images of the dye’s flow through the spinal column.
- The patient may be asked to change positions for different views.
Post-procedure Observation:
- Patients are monitored for a short period to ensure no adverse reactions.
Tools and Equipment
- X-ray machine
- Fluoroscopy equipment
- Contrast dye
- Sterile needles and syringes
Anesthesia or Sedation
- Local anesthesia to numb the injection site
- Sedatives, if necessary, to help the patient relax
Duration
The procedure typically takes about 1 to 2 hours, including preparation and post-procedure observation.
Setting
Myelography is performed in a hospital radiology department or an outpatient imaging center.
Personnel
- Radiologist (specialized in diagnostic imaging)
- Radiologic technologist or nurse
- Medical assistant
Risks and Complications
Common Risks
- Headaches
- Nausea
- Mild allergic reactions to the contrast dye
Rare Complications
- Infection at the injection site
- Bleeding
- Severe allergic reaction (anaphylaxis)
- Seizures (extremely rare)
Management
- Monitoring and managing reactions immediately
- Administering medications to address severe reactions
Benefits
- Provides detailed images for accurate diagnosis
- Assists in forming an effective treatment plan
- Benefits often realized shortly after image interpretation
Recovery
Post-procedure Care
- Lying down for several hours post-procedure to prevent headaches
- Hydrating well to help eliminate the contrast dye
- Avoiding strenuous activities for 24 hours
Expected Recovery Time
- Most patients resume normal activities within a few days
Follow-up
- Follow-up appointments to discuss results and treatment plans
Alternatives
Other Treatment Options
- MRI (if no contraindications)
- CT scan (for different types of imaging)
Pros and Cons of Alternatives
- MRI: No exposure to radiation but not suitable for patients with certain implants
- CT Scan: Quick and non-invasive but provides less detailed images of spinal nerve roots
Patient Experience
During the Procedure
- Mild discomfort from needle insertion
- Possible sensation of warmth from contrast dye
After the Procedure
- Likely to experience mild headaches or nausea
- Pain is usually minimal and managed with over-the-counter medications
Pain Management
- Over-the-counter pain relievers
- Adequate rest and hydration to minimize discomfort