CT-guided Spinal Infiltrations for Management of Back Pain: Indications, Imaging Technique, and Complications

Abstract

LEARNING OBJECTIVES
To discuss diagnostic and therapeutic advantages of image guided infiltrations for management of back pain. To compare CT- versus fluoroscopy-guided spinal procedures for management of back pain. To describe indications, imaging technique and complications of most commonly performed spinal infiltrations for management of back pain using CT-guidance

ABSTRACT
Chronic back pain constitutes a frequent source of suffering and disability. Spinal infiltrations have a favorable impact in certain pain states, and evidence shows advantages of image-guided infiltrations for management of back pain. Historically, fluoroscopy has been used for image guidance. Now, computed tomography (CT), has assumed a dominant role. CT offers theoretical advantages, such as higher spatial-resolution, potential to use smaller volumes and lower complication rate. Most commonly performed infiltrations include: nerve root, facet joint, epidural and sacro-iliac infiltrations.This exhibit reviews: 1) schematic description of image guided infiltrations; 2) Advantages of CT- over fluoroscopy-guidance spinal infiltrations; 3) Indications, optimal technique, selection of medications, administered doses, and complications for most commonly performed infiltrations. Radiologists should become familiar with these imaging guided procedures which may favorably impact patient care.