{"title":"The Importance of Image Guidance in Common Spine Interventional Procedures for Pain Management: A Comprehensive Narrative Review.","authors":"Martina Rekatsina, Philip W H Peng","doi":"10.1007/s40122-025-00731-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Image-guided spinal injections are commonly performed by pain physicians and supported by literature. A recent survey showed that half of the Canadian providers still perform landmark-guided injections. This comprehensive review aims to describe the evidence supporting imaging modalities (fluoroscopy, computed tomography (CT) and ultrasound) in improving the accuracy and safety in several commonly performed spine injections. Relevant anatomy and pitfalls of landmark-guided injections are also discussed.</p><p><strong>Methods: </strong>An extensive literature search was conducted in PubMed, Medline and Embase databases, complemented by a manual search. Search terms included all spine interventions and imaging modalities.</p><p><strong>Results: </strong>Literature shows that incorrect needle placement without imaging guidance can reach 50% in caudal, 30.4% in lumbar interlaminar and 53% in cervical interlaminar epidural steroid injections. Lumbar and cervical transforaminal steroid injections require imaging to identify intravascular or intradiscal needle placement; misplacement rates can be as high as 20% at cervical, 8% at thoracic, 6-15% at lumbar and 16.5-21% at sacral levels. Imaging techniques for sacroiliac joint steroid injections are superior to non-imaging techniques, while medial branch blocks and facet joint injections require image guidance.</p><p><strong>Conclusion: </strong>Image guidance is a mandatory requirement when performing spinal procedures for pain management. Fluoroscopy enhances the safety and accuracy of spinal injections, with stored images benefiting patient records. Ultrasound also has an increasingly important role either alone or with fluoroscopy. CT is also effective but with limited accessibility.</p>","PeriodicalId":19908,"journal":{"name":"Pain and Therapy","volume":" ","pages":""},"PeriodicalIF":4.1000,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pain and Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s40122-025-00731-9","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Image-guided spinal injections are commonly performed by pain physicians and supported by literature. A recent survey showed that half of the Canadian providers still perform landmark-guided injections. This comprehensive review aims to describe the evidence supporting imaging modalities (fluoroscopy, computed tomography (CT) and ultrasound) in improving the accuracy and safety in several commonly performed spine injections. Relevant anatomy and pitfalls of landmark-guided injections are also discussed.
Methods: An extensive literature search was conducted in PubMed, Medline and Embase databases, complemented by a manual search. Search terms included all spine interventions and imaging modalities.
Results: Literature shows that incorrect needle placement without imaging guidance can reach 50% in caudal, 30.4% in lumbar interlaminar and 53% in cervical interlaminar epidural steroid injections. Lumbar and cervical transforaminal steroid injections require imaging to identify intravascular or intradiscal needle placement; misplacement rates can be as high as 20% at cervical, 8% at thoracic, 6-15% at lumbar and 16.5-21% at sacral levels. Imaging techniques for sacroiliac joint steroid injections are superior to non-imaging techniques, while medial branch blocks and facet joint injections require image guidance.
Conclusion: Image guidance is a mandatory requirement when performing spinal procedures for pain management. Fluoroscopy enhances the safety and accuracy of spinal injections, with stored images benefiting patient records. Ultrasound also has an increasingly important role either alone or with fluoroscopy. CT is also effective but with limited accessibility.
期刊介绍：
Pain and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of pain therapies and pain-related devices. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also encouraged.
Areas of focus include, but are not limited to, acute pain, cancer pain, chronic pain, headache and migraine, neuropathic pain, opioids, palliative care and pain ethics, peri- and post-operative pain as well as rheumatic pain and fibromyalgia.
The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports, trial protocols, short communications such as commentaries and editorials, and letters. The journal is read by a global audience and receives submissions from around the world. Pain and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.
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