What Is Myelography?

Myelography (or a myelogram) is an imaging procedure that evaluates the spinal cord, nerve roots, and the spaces around them. It begins with a lumbar puncture (spinal tap), during which contrast dye is injected into the spinal canal.

After the contrast is injected, the radiologist takes X-rays or CT images. The contrast helps outline the spinal cord and nerve roots so that compression, herniation, tumors, or other abnormalities can be better visualized. A radiologist typically performs the procedure using fluoroscopic guidance.

Why Might I Need a Myelogram?

Your doctor may recommend a myelogram if you have:

• Symptoms of spinal cord or nerve root compression (pain, weakness, numbness)
• Suspected disc herniation, spinal stenosis, or other structural problems
• Need for detailed imaging of the spinal canal when MRI is contraindicated or inconclusive
• Evaluation of the spinal canal after prior surgery or when other imaging has not provided clear answers

How Do I Prepare?

Typical preparation includes:

• Medications: Tell your doctor about all medications, especially blood thinners. Certain blood thinners may need to be stopped for a period beforehand (only as directed).
• Hydration: You may be asked to drink extra clear fluids the day before the procedure.
• Eating: Follow any instructions about fasting or clear liquids on the day of the procedure.
• Allergies: Inform the team of any allergies to contrast dye, iodine, or local anesthetics.
• Transportation: Arrange for someone to drive you home. You should not drive yourself after the procedure.

How Is the Procedure Performed?

The procedure is usually done on an outpatient basis and takes about 30–60 minutes (plus recovery and imaging time).

Typical steps:

1. You lie on your stomach or side on a padded table. The lower back is cleaned with an antiseptic solution.
2. The provider injects a local anesthetic to numb the skin.
3. Using fluoroscopic guidance, a thin needle is carefully advanced into the spinal canal in the lower lumbar region.
4. The doctor injects contrast dye into the spinal canal. You may feel a brief warming, pressure, or mild discomfort.
5. The needle is removed, and a small bandage is applied.
6. X-ray or CT images are obtained. The table may be tilted slightly to help the contrast flow to the areas of interest.

What Should I Do for Aftercare?

Immediate Recovery

• You will need to lie flat (or with your head slightly elevated, as instructed) for several hours after the procedure. This helps reduce the risk of a cerebrospinal fluid leak and post-procedure headache.
• Drink plenty of fluids to help rehydrate and clear the contrast.
• Most patients go home the same day after observation.

Activity Guidelines

• Rest for the remainder of the day. Avoid strenuous activity, heavy lifting, and bending for 24–48 hours.
• You may usually return to light activity the next day if you feel well.
• Avoid airplane travel for a short period if your physician advises it.

What to Expect

• Mild backache at the puncture site is common.
• A headache that worsens when sitting or standing and improves when lying down can occur. Extra fluids, rest, and caffeine sometimes help. Contact your doctor if the headache is severe or persistent.

What Are the Risks?

Myelography is generally safe when performed by experienced physicians. Possible risks include:

• Post-procedure headache (most common side effect)
• Back pain or discomfort at the puncture site
• Allergic reaction to the contrast dye
• Bleeding or infection (rare)
• Rarely, nerve irritation or other neurological symptoms

Your physician will discuss the specific risks and benefits for your situation.

When Should I Call My Doctor?

Contact your healthcare provider if you experience:

• Severe or persistent headache that does not improve with lying down
• Fever, stiff neck, or increasing redness/swelling at the puncture site
• New numbness, tingling, or weakness in the legs
• Difficulty urinating or controlling bowel/bladder function