Re: Is A Myelogram Necessary For My Situation? Feeling Pressured

Posted By CCF neuro MD MM on October 16, 1998 at 07:54:23:

In Reply to: Is A Myelogram Necessary For My Situation? Feeling Pressured posted by Celeste Wells on October 16, 1998 at 03:30:07:






Dear Neurology Forum,
I was involved in an auto-accident on 3/23/98, and have had chronic
numbness and tingling in my right and left, hands and arms.  And in
my right leg, and toes of right foot.  I have not responded to anti-
inflamatories, they helped a little with severe neck pain, but did
nothing for numbness and tingling.  I had an MRI of cervical spine,
which showed mild midline disc protrusion at C5-6, and mild to moderate
midline to right sided eccentric disc protrusion at C6-7. Both these
showed on the sagittal sequence, but not well depicted on the axial
section at this level.  An MRI of the lumbar spine showed L4-5 minimal
osteophytic ridge and bulging disc, which just contacts the thecal
sac.  The cervial MRI was done on April this year, the lumbar done
in May.  I have had no success with with physical therapy in alleviating
any of my numbness/tingling/shooting pain, and neck pain.  Traction
to my neck has made it worse.  And now right hip pain is present along
with tingling/pain in toes, and down front shin.  I have weakness in
both right arm and leg.  
Now to get on to my question......the neurosurgeon I am seeing has
reccomended a myelogram.......to see if there is nerve compression
that did not show up on MRI,......and to see if there has been
any nerve damage.  My right arm literally aches and is weak, and
is in pain and tingling constantly.
Wouldn't an MRI be able to show any compression taking place?  I am
more comfortable with possibly another MRI, to see if anything has
changed, or gotten worse.  I expressed to the nurse my apprehension
about a myelogram. I decided to call the radiologist at the hospital
to ask about the risks involved in the myelogram.  The pamphlet the
doctors office scared me.......it said such things as "notify your
doctor if tremors or fainting occur".....etc.  This scares me to
pieces, and after talking with the radiologist....he gave me some
"worst case scenario" instances....(some VERY ill have passed away,
ie: heart attack during test, spinal nerve damage, bleeding, infection,
etc., etc.)  He said they are VERY rare.....but still possible risks.
He said the biggest side effect is headache.  Well.....after talking
to him, I cancelled the myelogram, too scared.  The nurse at the
doctors office was very rude to me, and told me the doctor does not
wish to do another MRI, and feels it would not be beneficial, and that
a myelogram plus CT is the only way the problem can be pinpointed, and
if I don't schedule the myelogram......basically this doctor (one of
only two board certified neurosurgeons in this city, the other is his
partner) cannot help me.  It is not my intention not to cooperate with
the doctor, I clearly want to get well. But would hate to go through
with this test due to pressure, but on the otherhand, I want to find
out what is going on,....and get to the bottom of it, so I can
see what needs to be done to get back to normal again.  
Could you please spell out the risks, and the probability of something
going wrong.  I am a healthy 31 year old woman, slightly heavy, with
high blood pressure, (diet controlled, no medication). I have since
spoken with two people who did just fine with a myelogram, and one
woman who has had two of them, and said she had no problems.  She just
laid down flat on her back for time reccomended.
Okay......now for my questions, I'm so sorry to make this so long, I
just wanted to explain everything, to see if you felt a myelogram is
needed in my case.
1. If there are complications during myelogram, what are the most
common.....and how are they treated?
2. Is an oil based dye better than a water based dye?  What is the
benefit of one over the other?
3. Do your nerves, disc's, bone's, all show up on a myelogram? And
is it clearly evident on the myelogram where the compressed nerves
are coming from, whether the nerve compression is being caused by
muscle, disk, bone, etc.?
Thank you so much for your time.  I feel I need reassurance to go through
with this test,.....anyone that has had this procedure, please feel
free to e-mail me or respond, with your experience, it may help to
calm me down.  Thank you again.
Sincerely,
C.Wells




A myelogram is basically a spinal tap in which something is injected into the
spine, therefore the complications are those of a spinal tap, your
physician obviously did a good job by telliny you of all the possible
complications even very rare ones, this is a very good practice but obviously
can cause worry also. I have done hundreds of Lumbar punctures and the only side
effect I have ever seen is headache, this largely avoided by lying down after
the procedure and treated with simple painkillers, caffeine and hydration.
As with any invasive procedure ther is the risk of infection. The most serious
side effect occurs in people who have raised pressure innthe head due to a brain
tumor, this can lead to the lower part of the brain slipping down intoo the
upper part of the spinal canal causing death, this is extremenly rare.
The dyes used give the same type of picture, one would be chose over
another usually if there is a history of allergy to one type.
The main structure seen on the myelogram due to the way the films are
taken is the fliud filled space which contains the dye mixed with spinal
fluids, indentations in this space are very obvious and so pressure on a nerve root is easily seen.
Other structures are not so clearly because of the specific penetration of
X rays in ths protocol, thsi the details of this are technical matters which a radiloogist would answer best.