同: ミエログラフイー,脊髄造影

WordNet

roentgenography of the spinal cord to detect possible lesions (usually after injection of a contrast medium into the subarachnoid space)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/04/03 03:44:52」(JST)

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Myelography is a type of radiographic examination that uses a contrast medium to detect pathology of the spinal cord, including the location of a spinal cord injury, cysts, and tumors. The procedure often involves injection of contrast medium into the cervical or lumbar spine, followed by several X-ray projections. A myelogram may help to find the cause of pain not found by an MRI or CT.

Myelography has been largely replaced by the use of CT and MRI scans.

Uses[edit]

A myelogram is sometimes used to better image the spinal cord in patients with lumbar spinal stenosis.^[1]

Procedure[edit]

A CT is typically performed after radiographic contrast media (dye) has been placed with fluoroscopic guidance into the sac (dura) surrounding the spinal cord and nerves. The material is typically water-based, which has largely replaced oil based fluids. A CT myelogram is most useful for patients who cannot undergo MRI (e.g., those with pacemakers or cochlear implants), or for those in whom MRI provides limited information (e.g., those with extensive metal in the spine).

The process usually involves lying face down on a table, with the lower extremities secured tightly with straps to the table. After the skin area has been numbed, the dye is injected into the spinal sac, then the table is slowly rotated in a circular motion, first down at the head end for approximately 4 to 6 minutes, then rotated up at the head end for the same duration. Several more minutes lying flat and the process is complete. This movement insures the contrast has sufficiently worked its way through the spinal cord, followed by X-rays, CT, or MRI scans.

If the fluid introduced in the spinal tap was oil based, the physician conducting the procedure will remove the fluid after the procedure is complete. When water-based fluid is used, it is typically not removed, as the fluid will eventually be absorbed into the body.

Post-procedure case centers around ensuring that infection does not set in and that the "plug" at the site of the spinal tap does not become dislodged. Patients are usually instructed to avoid strenuous activity and heavy lifting, for example. Some patients are given instructions to keep their heads elevated at least 30 degrees for a specified number of hours. Complications from the surgery can cause a loss of cerebrospinal fluid (CSF), which could cause severe headaches. This can be corrected by returning to the medical facility and having them perform a blood patch. In this procedure a small amount of blood is taken from the arm and injected into the exact spinal tap location to stop the leaking of CSF.

Myelography punction
Conventional myelography in oblique projection. You can see the individual nerve root sheaths.
Computed tomography after conventional myelography. The overlap-free representation often allows a more secure assessment. The high density of contrast material may be troublesome in case of insufficient mixing prior to CT.

References[edit]

^ Katz, Jeffrey N.; Harris, Mitchel B. (February 21, 2008). "Lumbar Spinal Stenosis". New England Journal of Medicine 358 (8): 818–825. doi:10.1056/NEJMcp0708097. Cite uses deprecated parameters (help)

Bontranger, Kenneth L. & Lampignano, John P. (2005). Radiographic Positioning and Related Anatomy, St. Louis: Elsevier Mosby. ISBN 0-323-02507-2.

External links[edit]

U of Maryland
Spinal Injury Foundation

UpToDate Contents

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English Journal

Imaging of lumbar spinal surgery complications.

Malhotra A1, Kalra VB2, Wu X3, Grant R4, Bronen RA5, Abbed KM6.
Insights into imaging.Insights Imaging.2015 Dec;6(6):579-590. Epub 2015 Oct 2.
Lumbar spine surgery for spinal stenosis is a frequently performed procedure and was the fastest growing type of surgery in the US from 1980 to 2000. With increasing surgical invasiveness, postoperative complications also tend to be higher. Cross-sectional imaging techniques (CT and MRI) are more se
PMID 26432098

Assessment of Obstetric Brachial Plexus Injury with Pre-Operative Ultrasound.

Smith EC1, Xixis KI1, Grant GA2, Grant SA3.
Muscle & nerve.Muscle Nerve.2015 Nov 13. doi: 10.1002/mus.24975. [Epub ahead of print]
INTRODUCTION: Tools used in the assessment of obstetric brachial plexus injuries (OBPI) have traditionally included electrodiagnostic studies, CT myelography, and MRI. However, the utility of ultrasound (US) in infants for such assessment has not been extensively examined.METHODS: This retrospective
PMID 26565729

Influence of Myelography and Postmyelographic CT on Therapeutic Decisions in Degenerative Diseases of the Cervical Spine.

Westermaier T1, Doerr C, Stetter C, Linsenmann T, Koehler S, Eriskat J, Solymosi L, Ernestus RI.
Journal of spinal disorders & techniques.J Spinal Disord Tech.2015 Nov 12. [Epub ahead of print]
STUDY DESIGN: A retrospective analysis of clinical records and radiologic imaging by 3 independent reviewers to assess the indication for surgical treatment with and without myelography and postmyelographic computed tomography (MCT).OBJECTIVE: To evaluate whether myelography and MCT obtained in addi
PMID 26566254

Japanese Journal

Vertebral replacement for the treatment of vertebral osteosarcoma in a cat

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NAID 130005637001

Methylprednisolone sodium succinate reduces spinal cord swelling but does not affect recovery of dogs with surgically treated thoracolumbar intervertebral disk herniation

Japanese Journal of Veterinary Research 64(3), 191-196, 2016-08
NAID 120005828519

最新原著レビュー頚椎後縦靱帯骨化症における脊髄圧迫の動態評価 : 脊髄造影後CT機能撮影

整形外科 = Orthopedic surgery 67(1), 95-97, 2016-01
NAID 40020700037

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