Myelogram Preparation Checklist: What to Do Before Your Spinal Imaging Procedure

Preparing for a Myelogram: Step-by-Step Guide

A myelogram involves injecting iodinated contrast into the spinal canal (via lumbar puncture) followed by CT or X-ray imaging. Proper preparation reduces risks and ensures diagnostic quality.

Pre-Procedure Instructions

1. Fasting: NPO (nothing by mouth) for 8–12 hours before the procedure to minimize nausea/vomiting risk during/after contrast injection.
2. Hydration: Drink extra clear fluids (water, clear broth, electrolyte drinks) the day before and morning of (until fasting begins) to optimize renal contrast clearance and reduce post-dural puncture headache risk.
3. Bladder Emptying: Void immediately before the procedure for comfort during prone positioning.
4. Medication Adjustments:
   • Continue most routine medications with a sip of water (unless instructed otherwise).
   • Hold anticoagulants/antiplatelets per prescribing physician (typically: warfarin 5 days, DOACs 24–48h, aspirin 7 days—always confirm with your doctor).
   • Sedation/Anxiolysis: May be offered (e.g., midazolam, fentanyl); arrange a driver if used.
5. Allergy Assessment: Report any history of:
   • Iodinated contrast reaction
   • Iodine/shellfish allergy (not a true contraindication but noted)
   • Latex allergy
   Premedication protocol (steroids/antihistamines) may be ordered for prior mild-moderate reactions.
6. Remove Metal Objects: Jewelry, piercings, belts, dentures, hearing aids in the imaging field.
7. Informed Consent: Discuss risks (headache 10–30%, bleeding, infection, nerve injury, seizure, contrast reaction) and alternatives with the performing physician.

Day-of Reminders

• Arrive 60–90 minutes early for check-in, labs (if needed), and consent.
• Wear comfortable, loose clothing; leave valuables at home.
• Bring prior imaging (MRI, CT, X-rays) for comparison.
• Plan for 2–4 hours total time; recovery observation 1–2 hours post-procedure.

Post-Procedure Care

• Bed rest with head elevated 30° for 4–24 hours per facility protocol.
• Continue aggressive oral hydration (2–3 L over 24h).
• Avoid strenuous activity, heavy lifting, bending for 24–48 hours.
• Report severe headache, fever, neck stiffness, leg weakness, or urinary retention immediately.