Myelogram

Myelogram is a diagnostic test that helps in detecting abnormalities of the spine, spinal cord and spinal fluid. A contrast dye is injected into the the neck area (cisternal myelogram) or in the lower back area (lumbar myelogram). Any abnormality or indentation on the spinal cord can be identified with a myelogram test. A bulging disc, tumor or herniated disk can lead to indentations on the spinal cord. A myelogram is conducted for patients who suffer spinal stenosis, herniated disc or inflammation of the arachnoid membrane. Myelogram aids in diagnosing problems of blood supply to the spine and tumors.

A myelogram is ideal for patients who have had metal implants in their spine, preventing them from undergoing an MRI scan or CT scan. A spinal tap is performed to inject the dye into the spinal sac. When combined with a CT scan, a myelogram helps in understanding the condition of the spinal bones and muscles. A patient scheduled for a myelogram must not eat for few hours prior to the test. Pregnant women and those with a history of asthma or epilepsy must keep the doctor informed.

Fluid intake must be maintained so as to remain well hydrated. Medications such as blood thinners, antidepressants and diabetes medicines may need to be temporarily stopped. A person is asked to lie down with head in elevated position for few hours after the myelogram test. The risks associated with a myelogram include meningitis, spinal headache and allergic reactions.

Stenosis

Unusual narrowing of the blood vessels or other tubular structures or organs is referred to as stenosis. In simple words stenosis means narrowing of the various body parts. The common causes for stenosis include birth defects, inflammation, neoplasm (abnormal proliferation of cells), ischemia (reduction of blood supply thus damaging tissues), infection, iatrogenic (complications arising from any treatment) and atherosclerosis.

Spinal stenosis: Specific causes include rheumatoid arthritis, osteoarthritis, aging, spinal injury or tumor and spondylosis. Symptoms include pain and weakness in the legs along with cramps, imbalance and loss of control over bladder and bowel movements.

Mitral valve stenosis: Specific causes include endocarditis, atrial myoxma, rheumatic fever and Lutembacher syndrome. Symptoms of mitral valve stenosis are fatigue, recurrent respiratory infections and swelling in the feet.

Aortic valve stenosis: This type of Stenosis may be caused by rheumatic fever, Williams syndrome, LDL receptor deficiency and senile or bicuspid aortic valves. The typical symptoms of aortic valve stenosis are chest pain and heart murmur, fatigue and shortness of breath and heart palpitations.

Pulmonary valve stenosis: Specific causes include deformity during fetal development, rheumatic fever and endocarditis. This type of stenosis has symptoms of cough and fatigue, fluid retention and shortness of breath.

Treatment differs according to the type of stenosis. While physical therapy, drugs like analgesics and lumbar brace are used to manage spinal stenosis, aortic valve stenosis and pulmonary valve stenosis are treated with valve replacement surgery.

Cauda Equina Syndrome

Lower back pain is normally not a panic situation. However in a few cases the pain could be due to cauda equina syndrome, which is a rare neurological condition and requires immediate medical attention rather surgical intervention.

Cauda equina is a Latin term which means horse's tail; the nerves at the end of the spine resemble the horse tail. Cauda equina is formed by the nerve roots caudal close to the termination point of the spine. Extreme compression or inflammation of the spinal nerve roots (nerves branching off the spinal cord). These nerves are located at the lumbar spine i.e. the lower end of the spinal cord. They help in transmitting messages to and from the legs, pelvic organs and feet. The syndrome is more common in adults but can occur in children too. If not treated immediately, it may lead to paralysis of the lower limbs, urinary incontinence, etc.

Cauda equina syndrome causes

• Spinal tumor or lesion
  
• Narrowing of the spinal canal or spinal stenosis
  
• Spinal infection, hemorrhage or fracture
  
• Ruptured disc in the lumbar region
  
• Herniated disc
  
• Inflammatory conditions
  
• Birth defect, this condition is more prevalent in adults however it can occur in children who are born with defects of the spine.
  
• Spondylolisthesis
  
• Accident/trauma

The condition is as such that it cannot be diagnosed very easily, common symptoms reported include severe lower back pain, sudden sexual dysfunction, pain, numbness or weakness in either one or both the legs or incontinence of bowel or bladder or retention of bowel or bladder movements. Diagnostic methods include:

• MRI
  
• Myelogram
  
• CT scan
  
• Urodynamic studies to monitor bladder function

Cauda Equina Syndrome Treatment

The condition cannot be prevented however it can be diagnosed at the early stages so as to prevent irreparable damages.

• Immediate treatment to ease pressure off the nerves.
  
• Surgery so as to prevent any further related complications caused by the condition.
  
• Treatment has to be given within 48 hours of onset of pain.
  
• Rehabilitation includes physical therapy and measure to handle bowel and bladder control.
  
• Anti-inflammatory medications.