Myelography
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| Myelogram | -radiologic exam of central nervous system structures within the spinal canal
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| Most common site of contrast injection | -L2-L3
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| Injection site for cervical exams | -C1-C2, cisterna cerebromedullaris
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| Structure that contrast is injected into | -subarachnoid space
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| Number of pairs of spinal nerves | -31
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| Spinal cord ends at the level of | -L1-L2
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| Spinal cord ends in a point called | -conus medullaris
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| Most common disk to herniate | -L5-S1
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| Types of contrast used | -opaque non-water-soluble / water-soluble nonionic iodinated / gas- air or O^2 (rarely used)
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| Pantopaque | -opaque non-water-soluble contrast used
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| Metrizimide | -water-soluble nonionic iodinated contrast used
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| Omnipaque 300 | -2nd generation; method of choice for cervical (or Pan myelogram)
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| Omnipaque 180 | -2nd generation; method of choice for lumbar
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| Type of contrast preferred due to fewer side effects | -Omnipaque
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| 2 Disadvantages of pantopaque (and other non-water soluble contrast) | -poor visualization of nerve root sheaths / body doesn’t absorb so has to be removed
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| 2 Advantage of water-soluble contrasts | - good visualization of nerve root sheaths / body absorbs readily
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| Common pt. positions (to open intervertebral spaces) | -prone with pillow under abd / lateral with spine flexed
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| This has to be done prior to contrast injection | -some CSF removed
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| Used to control direction and flow of contrast after injection | -gravity via use of tilting table
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| Reason head is extended and resting on chin during exam | -to compress cisterna magna which prevents contrast from reaching ventricles
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| Most common finding during myelogram | - HNP (herniated nucleus pulposus), slipped disc
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| Pan myelogram | -complete myelogram (cervical and lumbar)
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| 4 Indications for a myelogram | -HNP / bone fragments / tumors / swelling of spinal cord (due to injury)
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| Incomplete or partial dislocation of a vertebral body; usually due to injury | -subluxation
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| 2 Causes of compression fx | -injury to anterior section of vertebral body / spontaneously due to age (bone demineralization)
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| 750,000 Americans are affected by this type of spinal pathology each year | -compression fx
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| Deffective closure of the encasement of spinal cord; spinal cord and meninges may protrude through opening | -Spina Bifida
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| Forward displacement of one vertebra over another; commonly L5-S1 & L4-L5 | -Spondylolisthesis
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| Inflammation of vertabrae | -Spondylitis
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| Abnormal lateral curvature of the spine | -Scoliosis
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| Of the 4 types of Scoliosis, these 2 are most common | -Dextroscoliosis (spine shifts to R of body) / Levoscoliosis (spine shifts to L side of body)
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| 4 Contraindications | -prior lumbar puncture 2 wks ago / arachnoiditis / increased intracranial pressure / blood in CSF
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