When are myelograms indicated in the workup of lumbosacral radiculopathy?

Updated: Jan 25, 2018
  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
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Answer

Generally, the myelogram is reserved as a preoperative test, often performed in conjunction with a CT scan. This procedure provides a detailed anatomic picture, particularly of the spinal osseous elements, and the myelogram can be used to correlate examination findings and assist in preoperative planning.

Myelograms are rarely used in the nonoperative evaluation of patients with acute LBP, except in cases in which the clinical picture supports a progressive neurologic deficit and MRI and electromyography are nondiagnostic.

A study by Tong found that combining the findings of positive sharp waves (at least 30% motor unit changes) with the mini-paraspinal mapping score improves the ability to detect lumbar radiculopathy in patients with radiating low back pain. This combination of testing techniques increased the detection of radiculopathy from 27.1% when using findings of positive sharp waves alone to 50% when using the combination method. [9]


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