Myelography:

Myelography refers to specialized X-ray study, using fluoroscopy or general X-ray that is performed after the administration of a contrast agent into the epidural space of the spinal canal.  The contrast medium is a liquid that shows up white on an X-ray film.  The presence of the contrast agent provides an outline of the space surrounding the spinal cord and the nerve roots.  It is a good test for confirming the presence of a compressive or obstructive lesion.  Myelography is primarily used to evaluate spinal conditions such as tumors, canal stenosis, herniated discs, vascular malformations, disease or trauma to the spinal column.  The CT myelogram is a much more sensitive test as it combines multiple axial images through the areas in question rather than relying on plain film radiographic studies.

Nerve Blocks:

There are many types of spinal injections and nerve blocks can be performed to help identify the primary source of spinal pain.  Nerves become inflamed and painful for a variety of reasons.  Sometimes nerve compromise occurs secondary to obvious structural abnormalities.  In many cases there may not be imaging confirmation of obvious nerve compression or other structural compromise.  A series of specialized injections/nerve blocks may be performed as part of a differential pain workup. 

            Specialized forms of Nerve Blocks include:

            Epidural block: This is a nerve block performed under fluoroscopy.  A local skin

anesthetic is applied.  A spinal needle is then inserted into the epidural space of the spine.  An anesthetic agent and a steroid are administered.

Selective Nerve Root Block: This refers to a block performed under fluoroscopy.  The injection of an anesthetic agent and steroid is administered into the epidural space of a specific nerve root.

            Costovertebral Joint Block: This is a nerve block performed under fluoroscopic

guidance to help determine whether there is pain arising form a costovertebral

joint.  A local anesthetic agent is applied.  A needle is placed in the area of the

costovertebral joint and an anesthetic agent and steroid is injected.