Meet Dr. Gyorke, Tucson physician
As a Neuroradiologist in Tucson, Dr. Gyorke performs and interprets highly specialized, complex, and life-saving procedures. Neuroradiology is a specialized form of radiology focusing on the diagnosis and characterization of abnormalities of the brain, spine, and head and neck using neuroimaging techniques.
A Myelogram uses contrast material and X-rays, computed tomography (CT), or magnetic resonance imaging (MRI) to look for problems in the spinal canal, including the spinal cord, nerve roots, and other tissues.
Neuroradiology is on the leading edge of new advancements in radiology. However, it’s Dr. Gyorke’s genuine concern for his patients and their care that sets him apart.
A myelogram is an imaging examination of the spine performed after contrast material has been injected directly into your spinal canal to outline the spinal cord, nerve roots, and other spinal structures on X-ray, CT, and/or MRI images.
Conventional myelography utilizes a special form of X-ray called fluoroscopy and an iodine-containing contrast material that is injected directly into the spinal canal. Fluoroscopy makes it possible to see the bones and joints on “real-time” X-ray images. When contrast material is injected into the spinal canal, it is clearly visible on fluoroscopic and CT images and allows the radiologist to better detect abnormalities. While the injection is monitored with fluoroscopy, regular X-ray images are also obtained for documentation.
CT myelography is now almost always performed in conjunction with conventional myelography. CT uses X-ray pictures taken from multiple different angles to create cross-sectional images that appear as “slices” of the bones and surrounding structures.
MR myelography also involves the injection of contrast material into the spinal canal. However, the contrast material used for MRI evaluation is different from that used for conventional and CT myelography and contains gadolinium, which affects the local magnetic field and makes the contrast clearly visible only on an MRI examination. As in conventional and CT myelography, the contrast material outlines the structures within the spinal canal, allowing them to be evaluated by the radiologist on the MRI images. MRI uses a powerful magnetic field, radiofrequency pulses, and a computer to produce detailed pictures of organs, soft tissues, bone, and other internal structures. Unlike other imaging techniques such as X-rays and CT scans, MRI does not expose patients to the potentially harmful effects of radiation.
A myelogram is usually performed to evaluate for suspected compression of the spinal cord and/or nerve roots. Pressure on these structures typically causes a combination of pain, weakness, and numbness in the neck, back, or extremities. The most common causes of these symptoms are:
- Disk hernations, in which there is abnormal protrusion or extrusion of disk material between adjacent vertebrae into the spinal canal.
- Spinal stenosis, which often accompanies degeneration of the bones and soft tissues surrounding the spinal canal. In this condition, the spinal canal narrows as the surrounding tissues enlarge due to the development of bony spurs (osteophytes) and thickening of the adjacent ligaments.
In many cases myelography is performed after other studies, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, have not yielded enough information. Myelography can also be used to evaluate tumors, infections, suspected leakage of spinal fluid, and other conditions affecting the spine when MRI imaging cannot be performed or when it does not provide sufficient information. For patients who cannot have an MRI scan because they have a pacemaker or other implanted metallic device, CT myelography is often the best alternative.
A myelogram can often help determine if surgical treatment may be indicated and can help in surgical planning. In patients who already have spinal instrumentation (screws, plates, rods, etc.), your doctor may order CT myelography because the surgical hardware can produce extensive artifacts on MRI imaging that makes evaluation difficult.
You will be asked not to eat for 4 hours prior to the procedure. You may have clear liquids up to 2 hours before the procedure but should eat nothing after that.
If you are taking prescribed anticoagulants (blood thinners) such as Coumadin or Plavix, you should ask your physician for instructions prior to the procedure. Patients should not take over-the-counter aspirin or aspirin-containing medications for at least 5 days prior to their procedure. Please consult with your doctor or healthcare provider before stopping ANY medications.
Please arrive for your procedure with a responsible adult who can drive you home.
After you arrive for your appointment, you will be escorted to a procedure room, where you will be asked to change into a patient gown. You will be positioned on an exam table, and fluoroscopy will be used to determine the most appropriate needle entry site. The radiologist will cleanse the overlying skin, and a small amount of local anesthetic (lidocaine) will be injected with a small needle. You will feel a tiny pinch similar to a pinprick while the anesthetic is injected.
After the area becomes numb, the radiologist will insert a needle into the spinal canal while observing under fluoroscopy to ensure proper placement. After the needle has been properly positioned, a sample of your spinal fluid may be collected and sent to a lab for analysis if requested by your physician. The contrast material will then be injected through the needle into your spinal canal, and the needle will be removed. A bandage will then be placed over the insertion site. Depending on the area that is being examined, the table may be tilted at multiple angles in order to move the contrast into the area of interest. Several X-ray pictures will then be taken. In most cases, you will then be transported to the CT or MRI scanner for additional imaging.
During the exam you will lie on a table that moves into the doughnut-shaped scanner. Your technologist will watch you through an observation window and will be able to communicate with you at all times. CT scans are non-invasive and painless, though you will hear humming, buzzing, or clicking sounds as the CT machine moves to position you. It is very important to follow all instructions and remain still during scanning in order to obtain clear images.
The CT contrast agent is an iodine-based material. Radiology Ltd. uses only non-ionic contrast agents (the safest kind), but with all contrast agents there is always the potential for allergic reaction. Be sure to tell your technologist if you have experienced a reaction to CT contrast in the past. If you are diabetic and take Glucophage, Glucovance, or any other type of metformin medication to regulate your diabetes, you will need to stop taking it for 48 hours after your exam.
The MRI machine creates a magnetic field around you and directs radio waves at your body to create the MRI images. You won’t feel the magnetic field or radio waves, but you may hear loud tapping and thumping sounds coming from inside the machine. While the images are obtained, you will be instructed to breathe normally but to lie as still as possible. The technologist will monitor you from another room. You will be able to speak to the technologist through a microphone, and the technologist will also be able to talk to you.
The CT or MRI images will be evaluated by one of our neuroradiologists to ensure they are of diagnostic quality. After being monitored for a short time, you will be released with discharge instructions. The entire procedure usually takes about 45-60 minutes.
For your safety and the protection of others, we do not allow anybody except patients in our exam rooms.
Significant complications related to a myelogram are very uncommon. The primary risks associated with this procedure include:
- Allergic reaction to the contrast material
The most common side effect after a myelogram is a spinal headache, in which leakage of spinal fluid into the surrounding tissues produces a severe headache that typically worsens with standing. Spinal headaches usually resolve on their own, but an additional procedure called an epidural blood patch may be required to stop the leakage of spinal fluid and relieve the symptoms.
Most myelograms are very well tolerated, with minimal discomfort afterwards that is usually easily controlled with non-prescription pain medication. You may apply ice to the needle insertion site to reduce swelling if necessary. Symptoms usually disappear within 48 hours; contact your physician or healthcare provider if they persist for more than two days.
After your study, the images will be evaluated by one of our board-certified radiologists with expertise in neuroradiology. A final report will be sent to your doctor or healthcare provider, who can then discuss the results with you in detail.