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Myelography

QuestionAnswer
Myelogram -radiologic exam of central nervous system structures within the spinal canal
Most common site of contrast injection -L2-L3
Injection site for cervical exams -C1-C2, cisterna cerebromedullaris
Structure that contrast is injected into -subarachnoid space
Number of pairs of spinal nerves -31
Spinal cord ends at the level of -L1-L2
Spinal cord ends in a point called -conus medullaris
Most common disk to herniate -L5-S1
Types of contrast used -opaque non-water-soluble / water-soluble nonionic iodinated / gas- air or O^2 (rarely used)
Pantopaque -opaque non-water-soluble contrast used
Metrizimide -water-soluble nonionic iodinated contrast used
Omnipaque 300 -2nd generation; method of choice for cervical (or Pan myelogram)
Omnipaque 180 -2nd generation; method of choice for lumbar
Type of contrast preferred due to fewer side effects -Omnipaque
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
2 Advantage of water-soluble contrasts - good visualization of nerve root sheaths / body absorbs readily
Common pt. positions (to open intervertebral spaces) -prone with pillow under abd / lateral with spine flexed
This has to be done prior to contrast injection -some CSF removed
Used to control direction and flow of contrast after injection -gravity via use of tilting table
Reason head is extended and resting on chin during exam -to compress cisterna magna which prevents contrast from reaching ventricles
Most common finding during myelogram - HNP (herniated nucleus pulposus), slipped disc
Pan myelogram -complete myelogram (cervical and lumbar)
4 Indications for a myelogram -HNP / bone fragments / tumors / swelling of spinal cord (due to injury)
Incomplete or partial dislocation of a vertebral body; usually due to injury -subluxation
2 Causes of compression fx -injury to anterior section of vertebral body / spontaneously due to age (bone demineralization)
750,000 Americans are affected by this type of spinal pathology each year -compression fx
Deffective closure of the encasement of spinal cord; spinal cord and meninges may protrude through opening -Spina Bifida
Forward displacement of one vertebra over another; commonly L5-S1 & L4-L5 -Spondylolisthesis
Inflammation of vertabrae -Spondylitis
Abnormal lateral curvature of the spine -Scoliosis
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)
4 Contraindications -prior lumbar puncture 2 wks ago / arachnoiditis / increased intracranial pressure / blood in CSF
Created by: kairis276