A myelogram is a diagnostic imaging procedure used to examine the spinal canal, which houses the spinal cord and nerve roots. The test involves injecting a water-soluble contrast dye into the cerebrospinal fluid (CSF) space, typically in the lower back. Utilizing X-rays, often with a computed tomography (CT) scan, the dye highlights spinal structures to reveal abnormalities. This imaging is a valuable tool for diagnosing conditions like herniated discs, spinal stenosis, tumors, or nerve root compression when other methods, such as MRI, are inconclusive.
Standard Guidelines for Sedation
Deep sedation for a myelogram is generally avoided for most adult patients. Standard practice requires patient cooperation, as the patient must remain still while lying on a specialized table that may be tilted to help the contrast dye flow through the spinal canal. The medical team also needs the patient to be responsive to monitor for immediate adverse reactions, as the contrast dye carries a small risk of side effects, including seizures.
Deep sedation is typically reserved for rare exceptions, such as young children or adults with severe, uncontrolled movement disorders who cannot remain still. In these cases, a dedicated anesthesiologist must be present to manage the patient’s airway and monitor for complications, which significantly increases the procedure’s complexity and risk.
Pain Management and Anxiety Relief
While deep sedation is avoided, managing discomfort and anxiety is a primary focus. Pain control begins with administering a local anesthetic, such as lidocaine, at the injection site in the lower back. This numbing agent is applied before the main spinal needle is inserted, making the procedure much more tolerable. Patients typically report feeling a brief sting from the local anesthetic, followed by a sensation of pressure.
For patients experiencing significant anxiety, a mild form of conscious sedation may be offered. These medications, often anxiolytics, are given intravenously to promote relaxation without causing deep sleep. This helps the patient remain still and comfortable while staying alert enough to communicate and follow instructions.
Before and After the Myelogram
Preparation involves ensuring patient safety and maximizing imaging effectiveness. Patients are instructed to fast from solid food for several hours before the procedure. A review of current medications is necessary, as blood thinners may need to be temporarily stopped days in advance due to bleeding risks. Patients taking medications that lower the seizure threshold, such as certain antidepressants or muscle relaxants, may also be instructed to discontinue them 48 hours before and for a day after the test. Finally, a responsible adult must be arranged to drive the patient home following the appointment.
Post-Procedure Care
Post-procedure care is focused on preventing a spinal headache, which is the most common side effect caused by a small leak of cerebrospinal fluid (CSF) at the puncture site. Patients are instructed to lie flat or keep their head elevated no more than 30 degrees for several hours immediately after the procedure. Increasing fluid intake, specifically water and non-caffeinated drinks, is highly recommended to help replace lost CSF and flush the contrast dye from the system.
Monitoring Symptoms
Patients should avoid strenuous activity and heavy lifting for at least 24 hours. While mild soreness or fatigue is expected, symptoms like a severe headache persisting for more than 24 hours, fever, stiff neck, or new numbness and tingling in the legs require immediate medical attention. For a persistent post-procedure headache, a physician may recommend caffeine to help constrict blood vessels and alleviate the pain.