Preparation

Before a myelography, some preparation is necessary. The doctor is obliged to thoroughly inform the patient about the nature and necessity of the examination. He must also inform the patient about the general and intervention-specific risks.

In turn, the patient must give his written consent to the myelography at least one day before the examination. Blood is also taken on the day before the examination at the latest, and above all those blood values are checked that are important for normal blood coagulation. All blood-thinning medications (e.g. ASS 100 ®, Plavix ®, Godamed ®) must be discontinued in good time (approx.

7 days) to avoid an increased risk of bleeding. In most cases, a normal x-ray of the spine is available before myelography is performed. This allows the physician to determine the best access to the spine for the injection of the X-ray contrast medium.

In the patient’s medical history, it is necessary to ask about thyroid diseases such as hyperthyroidism, because an iodine image from the iodine-containing X-ray contrast medium can otherwise lead to a dangerous metabolic derailment of the thyroid gland. It is also important to clarify in advance whether an allergy to iodine exists, as an allergic reaction to the contrast medium can cause severe circulatory shock (anaphylactic shock). For reasons of hygiene, the patient is put on a surgical shirt on the day of the myelography.

An intravenous access is also provided. The main purpose of this is to be able to quickly administer drugs and fluid through the vein in case of allergic or other circulatory reactions. The myelography itself is performed in the clinic’s radiology department.

Myelography procedure

A myelography is usually performed in the lumbar spine area. The patient sits or lies in addition.In a sitting position, he is asked to bend forward and stretch the lower back towards the doctor. In a lying position, the feet should be pulled up to achieve a hunchback position as well.

This type of positioning spreads the vertebral bodies apart in the rear area. This makes it easier for the doctor to reach the spinal canal between the spinous processes of the vertebrae. The height of the puncture is then determined.

The physician is guided here by the x-ray image of the lumbar spine, the palpation findings of the spinous processes and typical anatomical features (landmarks), such as the height of the iliac crest. A thorough skin disinfection is then performed. Prepared in this way, the puncture itself is perceived as less painful by the patient.

If desired, the puncture site can be anaesthetized with a very thin needle with a local anaesthetic before the puncture. After the puncture, the physician advances the myelography needle (cannula) in the direction of the spinal canal. The physician recognizes that the spinal canal has been reached by a backflow of cerebrospinal fluid (liquor).

A small amount of cerebrospinal fluid is often given to the laboratory for further examination. Injury to the spinal cord itself is not to be expected during the puncture. The spinal cord as a structural unit ends at the level of the 1st -2nd lumbar vertebra.

Below this, the individual nerves of the spinal cord, floating freely in the neural fluid of the spinal tube (cauda equina), continue to move in the direction of the nerve exit holes assigned to them in the lower lumbar spine. When the spinal cord tube is punctured, the spinal cord nerves are easily displaced by the needle. There is no injury to the nerves.

Subsequently, 10-20 ml of a water-soluble X-ray contrast medium is injected. This is distributed in the spinal cord tube (dura tube) and flows around the spinal cord nerves until they leave the spinal column through their nerve exit holes. The exit of the spinal cord nerves is also surrounded for a short section.

Wherever there are bony, disc-related or other narrow spots, the flow of contrast medium is deflected or interrupted. After the injection of the contrast medium, the x-rays are taken: After the myelography, the patient is brought back to the ward. In order to avoid persistent headaches caused by the temporarily changed pressure conditions in the nerve water space (liquor space), bed rest must be maintained for 24 hours.

In addition, the patient should drink a lot to compensate for the loss of cerebrospinal fluid as quickly as possible.

Classical x-ray of the lumbar spine from the front (a. p.) and from the side: The width and space of the spinal cord space are shown on the basis of the distribution of the contrast medium. The spinal cord nerves are shown as contrast medium recesses.
Oblique radiographs of the lumbar spine, right and left adjacent: On these images, the outlets of the spinal nerves from the spinal canal are clearly visible.
Functional images of the lumbar spine in forward and backward flexion (lateral images): These X-ray images allow a statement to be made about the extent to which the forward and backward flexion of the upper body has an influence on the space available in the spinal canal.
For example, a disc can protrude visibly in the direction of the spinal canal during prophylaxis (anteflexion-inclination) and cause nerve pain, whereas in a straight position it is completely inconspicuous. In the clinical picture of spinal canal stenosis with spinal instability, however, the full extent of spinal canal narrowing and nerve pain is only revealed during retroflexion (retroflexion-reclination).
Myelo – CT: This is a computed tomography (CT) procedure following myelography. This sectional imaging technique, in combination with contrast medium injection, provides the most detailed images for the assessment of spinal canal narrowing and nerve constrictions.
The high contrast after injection allows nerves to be distinguished from other tissue types with millimeter precision. In addition, a three-dimensional image can also be produced by Myelo-CT.
Myelo – MRT: In this case, an MRT of the lumbar spine is performed after myelography.
Nerve root exit L4
Nerve root exit L5
Nerve root exit S1
Spinal cord tube with nerve fluid and spinal cord nervesSpinal nerves

Myelography serves to clarify many different complaints in the area of the spinal canal. When examining the cervical spine (cervical spine), these complaints often manifest themselves in the area of the upper extremities (arms, shoulder).

The patient often complains of radiating pain, paralysis and numbness. A frequent cause of these symptoms are masses of space (spinal canal stenoses) in the area of the cervical spine. This causes surrounding structures (especially nerves) to be compressed and irritated.

These masses often occur in the course of herniated discs, tumors and other spinal cord injuries. Bony changes in the area of the spine can also pinch the nerve roots and narrow the nerve exit openings. With the help of the injected contrast medium during myelography, these spatial demands can be clearly distinguished from the surrounding structures and diagnosed.

In rare cases in myelography of the cervical spine, the contrast agent is injected directly in the neck region instead of in the lumbar region. In addition to examining the cervical spine, myelography can also be used to diagnose complaints in the lumbar spine. Patients often report similar symptoms (radiating pain, paralysis, numbness), but these occur mainly in the lower extremity (legs) and pelvis.

The causes of these symptoms are also often spatial demands in the area of the spinal canal, which compresses and irritates surrounding nerves. These masses can be easily distinguished from the surrounding structures and diagnosed by administering a contrast medium. Possible masses can occur due to herniated discs, tumors, bony changes or other spinal cord injuries.

A myelography is usually performed in the lumbar spine area. During myelography, the patient is seated or lying down. In a sitting position, the patient is asked to bend forward and stretch the lower back towards the doctor.

In the lying position during myelography, the feet should be pulled up to achieve a hunchback position as well. This type of positioning spreads the vertebral bodies apart in the posterior region. This makes it easier for the doctor to reach the spinal canal between the spinous processes of the vertebrae.

The height of the puncture is then determined. The physician is guided here by the x-ray image of the lumbar spine, the palpation findings of the spinous processes and typical anatomical features (landmarks), such as the height of the iliac crest. A thorough skin disinfection is then performed.

Prepared in this way, the puncture itself is perceived as less painful by the patient. If desired, the puncture site can be anaesthetized with a very thin needle with a local anaesthetic before the puncture. After the puncture, the physician advances the myelography needle (cannula) in the direction of the spinal canal.

The physician recognizes that the spinal canal has been reached by a backflow of cerebrospinal fluid (liquor). A small amount of cerebrospinal fluid is often given to the laboratory for further examination. Injury to the spinal cord itself is not to be expected during myelography.

The spinal cord as a structural unit ends at the level of the 1st -2nd lumbar vertebra. Below this, the individual nerves of the spinal cord, floating freely in the neural fluid of the spinal tube (cauda equina), continue to move in the direction of the nerve exit holes assigned to them in the lower lumbar spine. When the spinal cord tube is punctured, the spinal cord nerves are easily displaced by the needle.

There is no injury to the nerves. Subsequently, 10-20 ml of a water-soluble X-ray contrast medium is injected. This is distributed in the spinal cord tube (dura tube) and flows around the spinal cord nerves until they leave the spinal column through their nerve exit holes.

The exit of the spinal cord nerves is also surrounded for a short section. Wherever there are bony, disc-related or other narrow spots, the flow of contrast medium is deflected or interrupted. X-rays are taken while the contrast medium is still being injected: After the myelography, the patient is brought back to the ward.In order to avoid persistent headaches caused by the temporarily changed pressure conditions in the nerve water space (liquor space), bed rest must be maintained for 24 hours.

You should also drink a lot to compensate for the loss of cerebrospinal fluid as quickly as possible.

Classical x-ray of the lumbar spine from the front (a. p.) and from the side: The width and space of the spinal cord space are shown on the basis of the distribution of the contrast medium. The spinal cord nerves are shown as contrast medium recesses.
Oblique radiographs of the lumbar spine, right and left adjacent: On these images, the outlets of the spinal nerves from the spinal canal are clearly visible.
Functional images of the lumbar spine in forward and backward flexion (lateral images): These X-ray images allow a statement to be made about the extent to which the forward and backward flexion of the upper body has an influence on the space available in the spinal canal.
For example, a disc can protrude visibly in the direction of the spinal canal during prophylaxis (anteflexion-inclination) and cause nerve pain, whereas in a straight position it is completely inconspicuous. In the clinical picture of spinal canal stenosis with spinal instability, however, the full extent of spinal canal narrowing and nerve damage is only revealed during retroflexion (retroflexion-reclination).
Myelo – CT: This is a computed tomography (CT) procedure following myelography. This sectional imaging technique, in combination with contrast medium injection, provides the most detailed images for the assessment of spinal canal narrowing and nerve constrictions.
The high contrast after injection allows nerves to be distinguished from other tissue types with millimeter precision.
Nerve root exit L4
Nerve root exit L5
Nerve root exit S1
Spinal cord tube with nerve fluid and spinal cord nervesSpinal nerves

A myelography is usually performed as an in-patient procedure. This is because patients must be monitored for at least 4 hours after the examination and bed rest is required. Depending on the patient, a one-day follow-up treatment may also be necessary.

Nevertheless, myelography is also being offered by more and more clinics as an outpatient diagnostic procedure. In this case, the patient must be informed about possible risk factors and indications in a preliminary consultation. Anticoagulant medication should be discontinued in most patients a few days before the examination. In addition, the patient should come to the appointment fasting. After the examination and the four-hour monitoring, the patient is not allowed to drive a car or operate machinery.