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Myelography – Spinal Canal Imaging Explained

Myelography is a diagnostic imaging procedure used to visualize the spinal canal and spinal cord by injecting contrast dye into the spinal fluid space.

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Things worth knowing about "Myelography"

Myelography is a diagnostic imaging procedure used to visualize the spinal canal and spinal cord by injecting contrast dye into the spinal fluid space.

What Is Myelography?

Myelography is a diagnostic imaging procedure in which the spinal canal – the bony channel within the vertebral column that houses the spinal cord – is visualized using a contrast agent injected directly into the subarachnoid space (the fluid-filled space surrounding the spinal cord). After the contrast dye is introduced, X-ray images or, more commonly, a computed tomography (CT) scan is performed to obtain detailed images of the spinal canal and surrounding structures.

When Is Myelography Performed?

Myelography is used when other imaging methods such as magnetic resonance imaging (MRI) are not sufficiently informative or cannot be performed – for example, in patients with implanted devices such as pacemakers. Common indications include:

Suspected herniated discs causing spinal canal narrowing
Spinal stenosis (narrowing of the spinal canal)
Tumors or metastases affecting the spine
Inflammatory conditions of the spinal cord or meninges
Suspected cerebrospinal fluid (CSF) leaks
Postoperative assessment following spinal surgery

How Is the Procedure Performed?

Preparation

Before the procedure, the patient receives a detailed explanation of the process and potential risks. Blood-thinning medications may need to be paused beforehand. Adequate hydration is recommended in the lead-up to the examination.

The Procedure

Myelography is performed under local anesthesia. A thin needle is inserted into the subarachnoid space – typically at the level of the lumbar spine (lower back) via a lumbar puncture. A water-soluble, iodine-based contrast agent is then injected into the cerebrospinal fluid (CSF) space. This contrast medium spreads through the fluid, and X-ray fluoroscopy or CT myelography is then used to visualize its distribution, revealing any narrowing, blockages, or structural abnormalities.

After the Procedure

Following the procedure, patients are advised to rest for several hours and to drink plenty of fluids to help flush out the contrast agent and reduce the risk of headaches. Post-lumbar puncture headaches are the most common side effect and result from a temporary drop in CSF pressure.

Risks and Side Effects

Myelography is generally a safe procedure, but potential risks include:

Headaches following lumbar puncture (post-dural puncture headache)
Nausea or dizziness related to the contrast agent
Allergic reactions to the contrast medium (rare)
Infection at the puncture site (rare when performed under sterile conditions)
Bleeding near the injection site (very rare)
Temporary neurological symptoms such as numbness (very rare)

Myelography vs. MRI

MRI of the spine has largely replaced myelography in many clinical settings, as it does not involve radiation or a spinal puncture. However, myelography remains a valuable tool – particularly for assessing dynamic spinal stenosis (changes in canal narrowing during movement or positional changes) and in patients for whom MRI is contraindicated. The combination of myelography followed by CT imaging (CT myelography) provides especially high-resolution detail of bony structures and the CSF space.

References

Reiser, M., Kuhn, F.-P., Debus, J. – Radiology (Radiologie). Thieme Verlag, Stuttgart, current edition.
Bartynski, W.S. – Myelography: Current Clinical Practice. Neuroimaging Clinics of North America, PubMed (PMID: 16584039).
Ross, J.S. et al. – Diagnostic Imaging: Spine. Elsevier, current edition.

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