Background
A myelogram is a particular type of radiograph whereby a contrast medium is injected into the cervical or lumbar spine to detect the location of an injury, cysts and tumors. Although myelography has been largely replaced by CT and MRI, in special instances, a myelogram may help to find the cause of pain not found by an MRI or CT.
Historical Overview
The technique of myelography was first described by Sicard and Forestier in 19211; by the end of that decade, it had become an established diagnostic approach.2,3 Although the procedure was elaborate, involving the intrathecal administration of contrast that had to be withdrawn using suction at the end of the procedure, myelography was the only diagnostic method available for decades that could be used to assess soft-tissue injuries and other neurological conditions, such as disc herniation and nerve root compression, which were not visible on conventional x-rays. In the 1970s and 1980s, the introduction of CT and water-soluble contrast agents made the procedure safer, easier to perform and more precise. Myelo-CT was first published by Di Chiro and Schellinger in 19764; it soon became a standard procedure. When MRI became clinical routine, myelography appeared obsolete. However, even today, it is a safe and well-established method for assessing special neurological conditions.5
Description
For safety reasons, even cervical myelography involves lumbar puncture and ascending contrast flow. The patient is prone, and the contrast is injected using fluoroscopy. A picture is taken with the needle in situ, and then the needle is removed. When the contrast has reached the lower part of the cervical spine, the patient is turned onto his/her stomach, and routine views are taken.
