Dr. Stefano Sinicropi, M.D.

Magnetic Resonance Imaging, also known more commonly as an MRI, is a wonderful diagnostic tool that uses magnetic waves to recreate a representation of an area inside the body. Unlike a standard X-ray that only really highlights bone formation, the MRI also shows a clear picture of soft tissues in the spine, making it ideal for assessing fractures, ligament tears, muscle injuries and more.

An offshoot of the X-ray is the myelogram, which involves injecting a specialist contrast dye into the spinal canal that allows key structures to be better viewed with an X-ray. But since we can obtain a clear view of the spine with an MRI without the added risks of injecting contrast dye into the spinal canal, why would we ever use a spinal myelogram instead of an MRI? We explore some instances where spinal myelograms are the right imaging technique in today’s blog.

Why Myelogram Over MRI?

As we touched on in the introduction, a spinal myelogram carries some additional risks compared to an MRI. There’s no need to worry about needle placement, cerebrospinal fluid leaking or a reaction to the contrast dye, and an MRI does offer excellent soft tissue contrast. A spinal myelogram was the standard for decades before the MRI really took off, but nowadays it’s reserved for more specific cases.

Some instances where a spinal myelogram may be ordered instead of an MRI to view spinal structures include:

• Pacemaker – If you’ve had a pacemaker inserted, it’s likely that a spine specialist will consider the myelogram over the MRI. Some older pacemakers cannot be safely used with an MRI, while more modern models are “MRI-conditional,” meaning they can be used as long as specific safety precautions are taken.
• Seeing Specific Areas – Some spinal areas are simply highlighted more clearly by a myelogram compared to an MRI, and that can ensure issues are not missed. For example, one study found that nerve root compression in the lateral recess is underestimated by MRI in nearly 30% of surgically confirmed cases compared to only 5-7% in myelography.
• Spinal Stenosis Cases – A myelogram can also be a more effective option when dealing with a patient with spinal stenosis. Studies have found that myelography tends to be more reliable than MRI when deciding which levels of decompressive lumbar spinal surgery should be performed in patients with spinal stenosis, and they’ve found MRIs tend to underestimate the width of the spinal canal and the foramina, in turn making spinal stenosis appear more severe than would with myelogram.
• Hematoma from Cerebrospinal Fluid Leak – Clinical reports have found that MRI is significantly inferior to myelography when looking to identify the location of a possible cerebrospinal leak. A dynamic visualization with contrast flow makes myelography a superior choice.

So while it’s not as popular as it was in the past thanks to medical advancements, it’s still an essential procedure for select patients and rare cases, so the technique will remain a key part of a skilled surgeon’s repertoire. To learn more about specific spinal procedures, or to get help with a back issue of your own, connect with Dr. Sinicropi and the team at Midwest Spine & Brain Institute today at (651) 430-3800.

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