Myelography

Myelography or Myelogram is used to make a diagnosis of spinal canal and spinal cord disorders like nerve compression that in turn causes pain and weakness. A special dye is introduced into the spinal sac that in turn shows up in the x-ray to signify any deformities. The dye acts as an exclusive agent to outline the nerve roots and the spinal cord thus helping the doctor determine if there are any abnormal shapes in the spinal cord. Before CT scans and MRI scans were introduced, it was myelography that was used to study any abnormalities in the spinal cord. Current medical world uses myelography only for complicated revision spine surgeries and for patients who have metal plates or screws in their spine. Myelography is primarily used to identify slipped disk by exactly locating the disk or disks concerned. Spinal arthritis can develop bone spurs that may press against the nerves and cause pain, myelography can help identify if surgery is required and can also help spot if the spinal canal is narrowed. Tumors can be accurately located. A patient preparing for myelogram must stop a solid diet for a day and drink plenty of clear fluids.

Anterior Cord Syndrome

Anterior Cord Syndrome refers to the Anterior Spinal Artery Syndrome. The anterior spinal artery originates from the vertebral arteries and basal artery at the base of the brain. It supplies the anterior two thirds of the spinal cord to the upper thoracic, that is chest, region. Anterior cord syndrome results from injury to the motor and sensory pathways in the anterior cord. Patients suffering from Anterior Cord Syndrome may feel some crude sensations, but their movement and more detailed sensation is lost. In Anterior cord syndrome there is damage primarily in the anterior 2/3 cord. This is related to vascular insufficiency, sparing the posterior columns. Anterior cord syndrome usually results from the compression of the artery that runs in front of the spinal cord. The compression may be from bone fragments or a large disc herniation.

• In Anterior Spinal cord syndrome, there is usually complete loss of strength below the level of the injury. Anterior spinal artery syndrome produces variable loss of motor function and of sensitivity to pinprick and temperature. Thus the patient undergoes complete sensory loss. But the sensitivity to vibration (vibratory sense) and position sense (proprioception) is preserved.
  
• In Anterior Cord syndrome, the anterior section of the spinal cord is injured. This results in loss of movement and sensory perception. In anterior cord syndrome, there is complete motor paralysis.
  
• In Anterior Cord Syndrome, there is sparing of the dorsal column. The patient therefore exhibits greater motor loss in the legs than arms.
  
• It is interesting to note 80% of spinal cord injuries occur in males. Children suffer spinal cord injuries due to sports activities. Adult suffer spinal cord injuries that are work related.

MRI is a most accurate imaging test for spinal disorders. This is because in MRI the spinal cord parenchyma, soft tissue lesions like hematomas, tumors and interverterbral disks, bony lesions like erosion, hypertrophic changes, collapse, fracture and subluxation are revealed. Myelography with a radiopaque agent is used less often. Physicians normally use CT scans to demonstrate bony fragments compressing the anterior spinal cord. X rays may help to detect bony lesions.

Anterior cord syndrome is said to have the worst prognosis of all cord syndromes. The prognosis is usually good if the recovery is evident and progressive in the patient during first 24 hours. However, if there are no signs of sacral sensibility to pinprick or temperature are present after 24 hours, then the prognosis for functional recovery can be said to be poor. There is no standard course of treatment or cure for anterior cord syndrome. Physicians adopt drug therapies and surgery as part of the treatment program. There have been some exceptional cases where sensations that travel along pathways are still intact after the injury. Normally, it is observed that only 10 to 15% of anterior cord syndrome sufferers demonstrate any improvement in functions over a period of time.