Today our topic of discussion is Myelography of Medical Surgical Procedures.
Myelography of Medical Surgical Procedures
MYELOGRAPHY
A myelography or myelogram is an X-ray of the spinal subarachnoid space taken after an opaque medium or air is injected into the spinal subarachnoid space through a spinal puncture. It is also a diagnostic procedure used to visualize the lumbar, thoracic or cervical areas or whole spinal axes for diagnosis of a spinal tumor, a herniated intervertebral disc or a ruptured disc.
Definition
Myelography is an X-ray examination of the spinal subarachnoid space taken after an opaque medium or air is injected into the spinal subarachnoid space through a spinal puncture. It shows any distortion of the spinal cord or spinal dural sac caused by tumors, cysts, herniated intervertebral discs or other lesions.
Purposes
- To identify space-occupying lesions of the spinal cord
- To help diagnosis a herniated nucleus pulposus
- To diagnose intramedullary tumors
- To identify the traumatic lesion and cysts of the vertebrae or the spinal cord.
Indications
- Spinal cord tumors
- Traumatic lesions of the spinal cord
- Herniated intervertebral disc.
General Instructions
- The client should be prepared physiologically and psychologically
- Strict aseptic technique should be followed throughout the procedure
- The client should be informed that the X-ray table may
- be tilted in varying positions during the study
- The commonly used dyes are mertrizamide (amipaque) and iophendylate (pantoopaque) so the sensitivity should be checked
- Instruct the client to remain supine for 12 to 24 hours after the procedure
- Inform the client that the procedure is done in department.
Client Preparation
- Explain the procedure to the patient and relatives Obtain informed consent
- The meal that would normally be eaten prior to the procedure is omitted
- The client may be given a light sedative to help cooperate.
- Sensitivity test for the dye must be checked.
- Procedure (Fig. 29.66)
- Place the client on the X-ray table
- Position the client for lumbar puncture
- LP needle is inserted L4-L5
- Approximately 10 ml of CSF is removed Water soluble nonionic contrast medium is then injected
- The table is tilted to allow the column of the dye to move up and down within the subarachnoid space.
- By minimal changes in position of the table and patient, various regions of the spine are screened and films taken at appropriate levels.
After Care
- Keep the client strict bed rest
- Position the client’s head elevated 30°
- Check the neurological and vital signs
- Encourage more oral fluids
- Provide light soft diet if no nausea and vomiting persists
- Mild analgesics may be given if headache
- Check the client’s ability to void
- Observe for fever, stiff neck, photophobia or the signs of chemical or bacterial meningitis.
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