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Semin intervent Radiol 2013; 30(03): 307-317
DOI: 10.1055/s-0033-1353484
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Interventional Spine Procedures for Management of Chronic Low Back Pain—A Primer

Jason D. Iannuccilli
1   Division of Interventional Radiology, Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, The Miriam Hospital, and Hasbro Children's Hospital, Providence, Rhode Island
,
Ethan A. Prince
1   Division of Interventional Radiology, Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, The Miriam Hospital, and Hasbro Children's Hospital, Providence, Rhode Island
,
Gregory M. Soares
1   Division of Interventional Radiology, Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, The Miriam Hospital, and Hasbro Children's Hospital, Providence, Rhode Island
› Author Affiliations
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Publication History

Publication Date:
13 September 2013 (online)

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Abstract

Chronic low back pain is a common clinical condition. Percutaneous fluoroscopic-guided interventions are safe and effective procedures for the management of chronic low back pain, which can be performed in an outpatient setting. Interventional radiologists already possess the technical skills necessary to perform these interventions effectively so that they may be incorporated into a busy outpatient practice. This article provides a basic approach to the evaluation of patients with low back pain, as well as a review of techniques used to perform the most common interventions using fluoroscopic guidance.

Keywords

back pain injections - spine intervention - epidural steroid injection - facet block - medial branch block - interventional radiology
 

  • References

  • 1 Friedly J, Standaert C, Chan L. Epidemiology of spine care: the back pain dilemma. Phys Med Rehabil Clin N Am 2010; 21 (4) 659-677
    CrossrefPubMedGoogle Scholar
  • 2 Weinstein JN, Lurie JD, Tosteson TD , et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA 2006; 296 (20) 2451-2459
    CrossrefPubMedGoogle Scholar
  • 3 Watters III WC, Bono CM, Gilbert TJ , et al; North American Spine Society. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. Spine J 2009; 9 (7) 609-614
    CrossrefPubMedGoogle Scholar
  • 4 Martin CR, Gruszczynski AT, Braunsfurth HA, Fallatah SM, O'Neil J, Wai EK. The surgical management of degenerative lumbar spondylolisthesis: a systematic review. Spine 2007; 32 (16) 1791-1798
    CrossrefPubMedGoogle Scholar
  • 5 Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the maine lumbar spine study. Spine 2005; 30 (8) 927-935
    CrossrefPubMedGoogle Scholar
  • 6 Weinstein JN, Lurie JD, Tosteson TD , et al. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 2007; 356 (22) 2257-2270
    CrossrefPubMedGoogle Scholar
  • 7 Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD. Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine 2009; 34 (10) 1094-1109
    CrossrefPubMedGoogle Scholar
  • 8 Deyo RA. Back surgery—who needs it?. N Engl J Med 2007; 356 (22) 2239-2243
    CrossrefPubMedGoogle Scholar
  • 9 Roine E, Roine RP, Räsänen P, Vuori I, Sintonen H, Saarto T. Cost-effectiveness of interventions based on physical exercise in the treatment of various diseases: a systematic literature review. Int J Technol Assess Health Care 2009; 25 (4) 427-454
    CrossrefPubMedGoogle Scholar
  • 10 Manchikanti L, Singh V, Pampati V , et al. Evaluation of the relative contributions of various structures in chronic low back pain. Pain Physician 2001; 4 (4) 308-316
    PubMedGoogle Scholar
  • 11 Cluff R, Mehio AK, Cohen SP, Chang Y, Sang CN, Stojanovic MP. The technical aspects of epidural steroid injections: a national survey. Anesth Analg 2002; 95 (2) 403-408
    CrossrefPubMedGoogle Scholar
  • 12 Stojanovic M. Basic pain management interventions using fluoroscopy: targets and optimal imaging of lumbar spine. Tech Reg Anesth Pain Management 2007; 11: 55-62
    PubMedGoogle Scholar
  • 13 Evron S, Sessler D, Sadan O, Boaz M, Glezerman M, Ezri T. Identification of the epidural space: loss of resistance with air, lidocaine, or the combination of air and lidocaine. Anesth Analg 2004; 99 (1) 245-250
    CrossrefPubMedGoogle Scholar
  • 14 Schaufele MK, Hatch L, Jones W. Interlaminar versus transforaminal epidural injections for the treatment of symptomatic lumbar intervertebral disc herniations. Pain Physician 2006; 9 (4) 361-366
    PubMedGoogle Scholar
  • 15 Staal JB, de Bie RA, de Vet HC, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low back pain: an updated Cochrane review. Spine (Phila Pa 1976) 2009; 34 (1) 49-59
    CrossrefPubMedGoogle Scholar
  • 16 Xu R, Bydon M, Gokaslan ZL, Wolinsky JP, Witham TF, Bydon A. Epidural steroid injection resulting in epidural hematoma in a patient despite strict adherence to anticoagulation guidelines. J Neurosurg Spine 2009; 11 (3) 358-364
    CrossrefPubMedGoogle Scholar
  • 17 Houten JK, Errico TJ. Paraplegia after lumbosacral nerve root block: report of three cases. Spine J 2002; 2 (1) 70-75
    PubMedGoogle Scholar
  • 18 Glaser SE, Shah RV. Root cause analysis of paraplegia following transforaminal epidural steroid injections: the 'unsafe' triangle. Pain Physician 2010; 13 (3) 237-244
    PubMedGoogle Scholar
  • 19 Binder DS, Nampiaparampil DE. The provocative lumbar facet joint. Curr Rev Musculoskelet Med 2009; 2 (1) 15-24
    CrossrefPubMedGoogle Scholar
  • 20 Boswell MV, Colson JD, Spillane WF. Therapeutic facet joint interventions in chronic spinal pain: a systematic review of effectiveness and complications. Pain Physician 2005; 8 (1) 101-114
    PubMedGoogle Scholar
  • 21 Van Zundert J, Vanelderen P, Kessels A, van Kleef M. Radiofrequency treatment of facet-related pain: evidence and controversies. Curr Pain Headache Rep 2012; 16 (1) 19-25
    CrossrefPubMedGoogle Scholar
  • 22 Shanthanna H, Chan P, McChesney J, Paul J, Thabane L. Assessing the effectiveness of 'pulse radiofrequency treatment of dorsal root ganglion' in patients with chronic lumbar radicular pain: study protocol for a randomized control trial. Trials 2012; 13: 52
    CrossrefPubMedGoogle Scholar
  • 23 Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother 2013; 13 (1) 99-116
    CrossrefPubMedGoogle Scholar
  • 24 Dussault RG, Kaplan PA, Anderson MW. Fluoroscopy-guided sacroiliac joint injections. Radiology 2000; 214 (1) 273-277
    CrossrefPubMedGoogle Scholar