MYELOGRAM - RT 255 - Student Notes PG 9
RADIOGRAPHIC EXAM OF THE CNS STRUCTURES WITHIN THE VERTERBRAL CANAL
CSF - Circulates in the subarachnoid space Betweeen the pia mater and sinal cord.
Space ends at 2nd sacral level Cord ends at lL1 or L2
Lower portion of lumbar veretral canal encases the CAUDA EQUINA – a collection of nerve roots
SCOUT FILMS
MYELOGRAM - RT 255 - Student Notes PG 9
PA & CROSS TABLE LATERAL
MYELOGRAM - RT 255 - Student Notes PG 9
CHECKS FOR: POSITIONING TECHNIQUE PATHOLOGY
MYELOGRAM - RT 255 - Student Notes PG 9
MYELOGRAPHY
MYELOGRAM - RT 255 - Student Notes PG 9
DEMONSTRATE
EXTRENSIC SPINAL CORD COMPRESSION (HERNIATED DISK)
BONE FRAGMENTS
TUMORS
SPINAL CORD SWELLING
ENCROACHMENTS ON SPINAL CANAL
Radiographically as a deformity of the subarachnoid space or obstruction of passage of column of contrast within space narrowing identified
MYELOGRAM - RT 255 - Student Notes PG 9
CONTAST MEDIA
MYELOGRAM - RT 255 - Student Notes PG 9
1st (OLD) – OIL BASED (Panopaque)
NEXT – Metrizimide (water sol)
NOW ISOVUE “M” 200 OR 300 M
NON-IONIC water based
INTRATHECAL INJECTION !!(into the subarachnoid space)
FOR LUMBAR AND CERVICAL INJECTION usually = L2-L3 OR L3-L4
MYELOGRAM - RT 255 - Student Notes PG 9
FOLLOW UP WITH CT SCAN W/IN 1 HR
Computerized Tomography (CT scan) with Myelogram provides for excellent nerve detail & nerver roots
The myelogram adds some additional risk and expense to the CT scan.
RISK
Potential for a spinal headache. The spinal headache usually resolves in one to two days with rest and fluids, and seems to be more common for patients with a history of migraine headaches.
CONTRAINDICATIONS
MYELOGRAM - RT 255 - Student Notes PG 9
CONTRAST ALLERGY/reaction -(not an IV injection)
CEREBRAL ANERUYSMS,
AV MALFORMATIONS
MYELOGRAM CAN INCREASE INTRACRANAIL PRESSURE
RECENT LUMBAR PUNCTURE 1 week
MYELOGRAM - RT 255 - Student Notes PG 9
C.SP = CISTERNA CEREBELLOMEDULLARIS – do not let contrast spill = BIG Headache
PROCEDURE
MYELOGRAM - RT 255 - Student Notes PG 9
CONSENT SIGNED !!! PATIENT PREP PATIENT COMFORT
MYELOGRAM TRAY READY SCOUT FILMS TAKEN
add – cisternal puncture done when l.sp damaged or just to see c.sp
MYELOGRAM - RT 255 - Student Notes PG 9
Pt placed prone. Space located and marked under fluoro – by Radiologist. Place your marker on screen on fluoro tower (check position before placing pt on table) Needle is inserted into the spinal canal after xylocaine injection = small amount of spinal fluid is removed for testing.(mark tubes immediately with patient ID labels). Contrast material is then injected into the spinal canal(sub arachnoid space). The table is tilted to varying degrees to help move the contrast material through the spinal canal to the desired area. Fluoro spot films and Overhead X-rays are taken to visualize the outlined canal.
After the Myelogram
With water-based contrast material - .Take medication for headache, nausea, or vomiting -- if they should develop after the myelogram. Light activity for 24 hours after discharge - head of the bed may be up 15 to 30 degrees
Drink plenty of fluids - May have some aching/ muscle spasms in the area where the myelogram was done - should not last longer than 1-2 days.
SOME COMMON SPINAL PATHOLOGIES
Degenerative disc disease is the normal manifestation of the aging process
The discs function as a shock absorber and cushion between the vertebrae
DJD can lead to narrowing or collapse the disc space in the lumbar spine
Disc Herniation Repetitive tears to the annulus thins the wall and may lead to a disc rupture
The disc rupture presses a spinal nerve(s) against the bony surface of a vertebra. This condition is often referred to as a ruptured disc. Even pressure from everyday activities can push the disc through the torn or cracked annulus and pinch a spinal nerve root(s). When we increase the stresses of the disc with lifting, bending or twisting, low back pain may occur.
Spondylolisthesis there is a slipping of one vertebral body in any direction in relation to the one below it.
A forward, or anterior displacement is most common
PAIN MANAGEMENT (C-ARM) - Fluoro used to check and document location of injections
Cortisone Injections: can be injected into the epidural space and offer temporary relief by decreasing inflammation. Many patients respond well to conservative management with decreased or manageable pain levels and improved activity levels.
This positive response may be temporary, or may last for quite a few years.
Osteoporosis & Fractures (Bone Densitometry)
28 million people are at risk, due to fragile bone structure, for an osteoporotic fracture:
MYELOGRAM - RT 255 - Student Notes PG 9
700,000 spinal fractures -one every 45 seconds
300,000 hip fractures
250,000 wrist fractures
250,000 other types of fractures.
MYELOGRAM - RT 255 - Student Notes PG 9
Cervical neck conditions range from mild neck stiffness to severe pain with weakness.
Intermittent neck pain often described as a “dull ache.”
Stiffness involving the neck and increased pain associated with turning the head in one or both directions may be present.
Neck Pain - Pain radiating into the shoulder or shoulder blade.
Pain and/or numbness extending into the arm, hand, and fingers.
Weakness of the arm or hand grip, which may be accompanied by muscle atrophy (the reduction in size of a muscle) Weakness involving the legs or loss of coordination
RADIOGRAPHIC IMAGES AND PATHOLOGY - WHAT DO YOU SEE?
THE END
HNP – ADD FOR 2008
CSF
• Circulates in the subarachnoid space
• Betweeen the pia mater and sinal cord.
• Space ends at 2nd sacral level
• Cord ends at l1 or l2
• Lower portion of lumbar teretral canal encases the CAUDA EQUINA – a collection of nerve roots
SCOUT FILMS
• PA
• CROSS TABLE LATERAL
• CHECKS FOR
• POSITIONING
• TECHNIQUE
• PATHOLOGY
MYELOGRAPHY
• DEMONSTRATE
• EXTRENSIC SPINAL CORD COMPRESSION (HERNIATED DISK)
• BONE FRAGMENTS
• TUMORS
• SPINAL CORD SWELLING
ENCROACHMENTS ON SPINAL CANAL
• RADIOGRAPHICALLY AS A
• DEFORMITY OF THE SUBARACHNOID SPACE
• OR OBSTRUCTION OF PASSAGE OF COLUMN OF CONTRAST WITHIN SPACE
• NARROWING IDENTIFIED
CONTAST MEDIA
• OLD – OIL BASED (Panopaque)
• NEXT – Metrizimide (water sol)
• NOW
• NON-IONIC water based
– ISOVUE “M” 200 OR 300 M
– INTRATHECAL INJECTION !!
– FOLLOW UP WITH CT SCAN W/IN 1 HR
SPECIAL PROCEDURS
CONTRAST MEDIA
MYELOGRAMS
– Injected INTRATHECALLY
(into the subarachnoid space)
– Nonionic water-soluble contrast
– (NO IONIC CONTRAST)
31 y/o male DIES
after Myelogram Procedure
• Myelography is safely performed using
• nonionic water-soluble radiographic contrast media intended for this route of administration
• Misadministration of ionic contrast media intrathecally can result in a syndrome of spasms and convulsions, often leading to death
• ISOVUE –M ( 20 or 30 cc)
Computerized Tomography (CT scan) with Myelogram
• When combined with a myelogram, a CT scan provides for excellent nerve detail.
• The myelogram adds some additional risk and expense to the CT scan but provides substantial information about the nerve roots.
RISK
• The main risk with a myelogram is the potential for a spinal headache.
• The spinal headache usually resolves in one to two days with rest and fluids, and seems to be more common for patients with a history of migraine headaches.
CONTRAINDICATIONS
• ?? CONTRAST ALLERGY/reaction
• CEREBRAL ANERUYSMS,
• AV MALFORMATIONS
• MYELOGRAM CAN INCREASE INTRACRANAIL PRESSURE
• RECENT LUMBAR PUNCTURE 1 week
CONTAST MEDIA
• INTRATHECAL INJECTION
– L2-L3 OR L3-L4
– FOR LUMBAR AND CERVICAL INJECTION
– CISTERNA CEREBELLOMEDULLARIS
– C.SP
PROCEDURE
• CONSENT SIGNED !!!
• HISTORY TAKEN
• PATIENT PREP
• PATIENT COMFORT
• MYELOGRAM TRAY READY
• SCOUT FILMS TAKEN
• During the examination, you will lie on your side, or on your stomach, on an x-ray table.
• After numbing medicine is injected, a needle is inserted into the spinal canal (in the low back or neck), and a small amount of spinal fluid is removed for testing.
• The contrast material is then injected into the spinal canal.
• The table is tilted to varying degrees to help move the contrast material through the spinal canal to the desired area. X-rays are taken to visualize the outlined canal.
• If you received an oil-based contrast material, you will be able to turn on your back, stomach, or sides, but must remain flat in bed for 24 hours.
• If you received a water-based contrast material, you must remain in bed for 24 hours, but the head of the bed may be up 15 to 30 degrees.
• You will be routinely checked for blood pressure, temperature, pulse, and respirations.
• Medication is available for headache, nausea, or vomiting -- if they should develop after the myelogram.
• You will be encouraged to drink lots of fluids.
After the Myelogram
• Light activity for 24 hours after discharge
• Drink plenty of fluids
• aching in the area where the myelogram was done or muscle spasms in your back.
• Various aches and discomfort in your arms/legs should not last longer than 1-2 days.
• If you experience continuous mild to severe headaches, there may be a small leak of spinal fluid. This generally is not dangerous. If symptoms do not resolve the leak can be sealed over with a blood patch. This is done by the anesthesiologist.
• If you are on any antidepressant medication, please check with your doctor.
Degenerative disc disease
is the normal manifestation of the aging process
• The discs function as a shock absorber and cushion between the vertebrae.
• As we age, the water content of the disc decreases, and the disc becomes dry.
• The lumbar spine supports the weight of the entire spinal column.
• significant motion occurs between the lumbar vertebrae,
• These two factors influence the process leading to narrowing or collapse the disc space in the lumbar spine
Disc Herniation
• Repetitive tears to the annulus thins the wall (similar to a bald spot on a tire) and may lead to a disc rupture (similar to a tire blowout)
• The disc rupture presses a spinal nerve(s) against the bony surface of a vertebra.
• This condition is often referred to as a ruptured disc.
• Even pressure from everyday activities can push the disc through the torn or cracked annulus and pinch a spinal nerve root(s).
• weakening of the ligament structures, and degeneration of the lumbar discs
• When we increase the stresses of the disc with lifting, bending or twisting, low back pain may occur.
• Larger or repetitive stresses, such as shoveling the snow, may produce tears in the annulus (fibrous casing that contains the disc).
Spondylolisthesis
• there is a slipping of one vertebral body in any direction in relation to the one below it.
• A forward, or anterior displacement is most common
• Degenerative spondylolisthesis is more prevalent in females than in males
PAIN MANAGEMENT
(C-ARM)
• Cortisone Injections:
• can be injected into the epidural space and offer temporary relief by decreasing inflammation.
• Many patients respond well to conservative management with decreased or manageable pain levels and improved activity levels.
• This positive response may be temporary, or may last for quite a few years.
Osteoporosis & Fractures
• 28 million people are at risk, due to fragile bone structure, for an
• osteoporotic fracture:
• 700,000 spinal fractures -one every 45 seconds
• 300,000 hip fractures
• 250,000 wrist fractures
• 250,000 other types of fractures.
cervical neck conditions
• range from mild neck stiffness to severe pain with weakness.
• Intermittent neck pain often described as a “dull ache.”
• Stiffness involving the neck and increased pain associated with turning the head in one or both directions may be present.
Neck Pain
• Pain radiating into the shoulder or shoulder blade.
• Pain and/or numbness extending into the arm, hand, and fingers.
• Weakness of the arm or hand grip, which may be accompanied by muscle atrophy (the reduction in size of a muscle)
• Weakness involving the legs or loss of coordination
RADIOGRAPHIC IMAGES AND
PATHOLOGY
WHAT DO YOU SEE?
THE END
Spondylolisthesis.
Lateral view of lower lumbar spine shows break in pars interarticularis (arrow), with resultant anterior slippage of L4 with respect to L5
Lumbar disk herniation.
Myelogram shows extradural lesion
MR image of intervertebral disk herniation in cervical region
Hangman's fracture