Basic neuroradiology procedures part 3 - Myelogram 

You are right that most people can get the same information from MRI, so myelography is a relatively uncommon procedure these days. We always recommend MRI when possible and when it provides the necessary information. No one should have a procedure when a non-invasive test will provide the same or better information. However, there are still some limited times where we need to use myelograms, such as surgical planning, when people have MRI unsafe implants or devices, or when metal from prior surgery obscures the results of an MRI. In those cases, the benefits of a CT myelogram can outweigh the risks. We talk about all of this before our procedures to help patient decide together with us if it is the best test for them. No one is being blasé about pain or discomfort of a patient, which we do not want. However, you are overstating the discomfort and risk of a myelogram which may scare patients who truly need one. After any lumbar puncture, there is a risk of a headache, but the vast majority go away within a couple of days with conservative management (like tylenol and fluids). When headaches last longer, we sometimes perform a blood patch, but like myelograms, we try to minimize procedures because they are painful and have risks of their own. There is a lot of anecdotal misinformation about myelography, of which the fact that they are super painful or risky is most common. Much of that was from old contrast agents, which have significantly improved in the last 30 years. In this era, the vast majority of our patients have safe myelograms with no significant pain and report that it was much better than they expected.