There are a number of different spinal interventional procedures that can help diagnose and manage low back pain. Lumbar degenerative facet joints, lumbar disc disease and sacroiliac joint pain account for nearly 70% of cases of lower back pain.
Unfortunately, as the incidence of degenerative changes in the spine is so high (e.g. disc abnormalities are found in 25% of individuals below the age of 60 and over 50% in those over the age of 60), it is sometimes difficult to confidently identify the cause of pain, without careful correlation with clinical findings and potentially diagnostic injections. The other role of spinal injections is to treat non-operative back pain.
On this page:
Procedures
All these procedures require precise needle tip position and therefore are performed with imaging guidance, either fluoroscopy or CT.
General contraindications
The following are general contraindications to elective spinal international procedures:
active sepsis
known allergy to local anesthetic/steroids/contrast agents
pregnancy
bleeding tendencies
anticoagulation
repeated injections: maximum 3-4 per year recommended to avoid complications such as osteoporosis 6
upcoming surgery: increased post-operative infection rates of an epidural corticosteroid injection has been performed within 1-3 months of surgery 6
Complications
Neurological complications
intra-arterial injection can results in spinal cord or cerebral infarction
neural compression or ischemia
benzyl alcohol has caused necrosis and apoptosis of retinal pigment epithelial cells
direct nerve trauma
Vascular complications
bleeding with possible epidural hematoma requiring evacuation or resulting in weakness and other sequelae 6
Infectious complications
infection with possible epidural abscess requiring evacuation or resulting in weakness and other sequelae
Medication-related complications
repeated steroid injections may result in epidural lipomatosis and osteoporosis 6
steroid flare with worsening pain for 2-3 days 6
gastritis (especially if the patient is on concurrent NSAIDs)
intrathecal injection of steroids may result in arachnoiditis; this is mainly due to excipients such as polyethylene glycol
decrease in diabetic control
allergic reaction to contrast agents, medications, etc.
Equipment
Typical equipment required includes but varies depending on procedure, patient and proceduralist preferences 6:
skin wash and sterile drape
hypodermic needle with syringe for local anesthetic to skin and soft tissues
-
spinal needle with syringe for target injection
cervical and thoracic injections: 21-25G, 4-8 cm length
lumbar injections: 20-21G, 7-12 cm length
-
target injection
local anesthetic, e.g. 1 mL 0.5% bupivacaine, 1 mL 0.2% ropivacaine
non-particular steroid (e.g. dexamethasone) preferred for spinal injections