Myelography is the traditional X-ray method for spinal diagnosis. The method is associated with radiation exposure and the introduction of a special substance into the subarachnoid region of the spine. Often used in conjunction with newer diagnostic procedures.
MRI with myelography , what is this examination method
MRI is a method in which, as a result of the response of water in tissues to the effect of a magnetic field, sections of the desired projections of the spine and a volumetric image of problem areas are compiled.
An accurate highly informative diagnostic method has found widespread use. In a number of other studies, MRI differs in that it does not have harmful radiation effects on the body and is performed without interfering with it.
The method replaces many other examinations, including myelography . This is due to the fact that MRI of the spine “sees” well and scans the state of soft tissues.
There are times when MRI is contraindicated due to the presence of metal objects and implanted devices in the body. Then myelography may be prescribed to study the condition of the spine.
Sometimes myelography is done to complement the MRI investigation of the problem and is done in conjunction with an MRI. This happens when you need to determine:
- tumor formations in the tissues of the spine, including the spinal cord,
- pathologies of any nature,
- infections affecting the tissues of the spine.
The improvement of the MRI method gave rise to the method of MR- myelography . It became possible to obtain complete information about the cerebrospinal fluid-containing cavities of the spinal cord in a non-invasive way that does not carry radiation exposure.
When scanning information, the signal from the spinal cord is suppressed and amplified from the space between the membranes filled with spinal fluid. Enables visualization of cysts, cerebrospinal fluid (spinal fluid).
Diagnostic benefits
Myelography in the classic form – X-ray examination of the state of the spine with the introduction of contrast into the spinal canal.
The image is obtained by the method of radiography, a more modern and information-capacious method is computed tomography.
The benefits include:
- The contrast agent makes the nerve roots, the contours of the spinal cord visible to specialists.
- Some abnormalities are detected by myelography , without contrast, CT does not detect them.
- Radiation during the procedure does not leave traces in the body.
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Contrast myelography : indications for
The procedure is carried out if necessary:
- studying vascular problems in the spine,
- with weakness, pain and a feeling of numbness in the limbs – in order to determine the causes of these symptoms,
- identification of injury to the nerve roots,
- determining the presence of tumors and the causes of their occurrence,
- diagnosing the inflammatory process,
- diagnosing hernias,
- determination of the inflammatory process of the spinal cord arachnoid – arachnoiditis,
- detection of infections of the nerve processes and the spinal canal,
- studies for the presence of malignant tumors in the area of the posterocranial fossa,
- detection of narrowing of the spinal cord canal – stenosis,
- determining the consequences of spinal injuries.
Possible complications
- There is a risk that there will be an allergy to the substance introduced during the procedure, so skin tests are done.
- A fifth of patients after the procedure complain of headache. It usually goes away in a day.
- There is nausea and vomiting.
- Convulsions are possible.
- Hearing loss is a rare complication.
- If the patient is diabetic and takes metformin , kidney problems may occur.
- After the procedure, one should lie so that the head is higher in relation to the rest of the body in order to avoid the flow of the substance introduced during the procedure into the brain. Otherwise, there is a risk of seizures.
- Numbness, paralysis – this complication is rare.
- A very small percentage of the likelihood of an infection in the cerebrospinal fluid during the injection of a substance for myelography or other trouble – bleeding from the injection site.
- A rare complication is the occurrence of a block in the spine (in the area of the puncture). Surgery will be required.
- A rare occurrence – after taking a puncture, the hole does not close and cerebrospinal fluid flows out. Surgical operation will help eliminate.
Contraindications
Factors in which myelography should not be performed :
- if the patient cannot lie still during the examination,
- pregnancy,
- inflammation of the skin in the place where it is necessary to make a puncture for the introduction of the substance,
- feverish conditions
- severe arthritis,
- during the examination, exacerbation of kidney, heart, liver diseases,
- anatomical congenital anomalies of the spine or injuries that make it difficult to inject the substance,
- surgical interventions in the spine.
Training
Before the procedure, you need to do:
- If myelography is performed on the cervical spine, you must take a sedative, which your doctor advises. This is to suppress the swallowing reflex.
- If the procedure will be performed on the lumbar spine, the intestines are cleaned with an enema before it is carried out.
- On the eve of the study, it is necessary to stop eating for eight hours.
- In the diagnostic area, remove all objects that might obstruct the X-rays.
Warn doctor:
- If you are allergic to iodine preparations and other substances.
- If you have been taking any medication.
- If there is a violation of blood circulation before the procedure.
- If there are chronic diseases: asthma, epilepsy, diabetes, kidney disease and others.
How is the procedure performed
- The puncture site is disinfected and anesthetized.
- The needle is guided into the subarachnoid area under fluoroscopy. When it reaches the cerebrospinal fluid, this substance begins to flow into the needle. If necessary, you can take a small amount of it for analysis.
- A radiopaque substance is introduced . After that, the needle is removed and the puncture site is disinfected again.
- During the puncture procedure, the patient lies on his side, sits or lies on his stomach – it depends on where the needle is inserted.
- After that, the patient lies face down on the table.
- The doctor tilts the table up and down, allowing the contrast agent to spread through the spinal canal. The doctor controls this process with a fluoroscope , paying attention when the affected area appears.
- During the procedure, the patient lies motionless. The doctor may suggest changing the position of the body when examining the problem area for a more detailed study.
- After myelography , a computed tomography procedure is performed using the moment that a contrast agent is in the subarachnoid space. The combination of myelogram and computed tomography techniques is called CT myelography .
Duration of CT myelography :
- the duration of myelography is 30? 60 minutes,
- computed tomography takes 15? 30 minutes,
- total examination time 45? 90 minutes.
After the procedure, the patient should lie down for about a day, while the head area should be kept on an elevation. This time it is desirable to be under the supervision of a doctor, to drink more fluids.