The Importance of Image Guidance in Common Spine Interventional Procedures for Pain Management: A Comprehensive Narrative Review
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...
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Adis, Springer Healthcare
2025-04-01
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| Series: | Pain and Therapy |
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| Online Access: | https://doi.org/10.1007/s40122-025-00731-9 |
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| author | Martina Rekatsina Philip W. H. Peng |
| author_facet | Martina Rekatsina Philip W. H. Peng |
| author_sort | Martina Rekatsina |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-8a8aeb0fab40424fbd5ab3fdc811455c |
| institution | OA Journals |
| issn | 2193-8237 2193-651X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Pain and Therapy |
| spelling | doaj-art-8a8aeb0fab40424fbd5ab3fdc811455c2025-08-20T01:51:59ZengAdis, Springer HealthcarePain and Therapy2193-82372193-651X2025-04-0114384186310.1007/s40122-025-00731-9The Importance of Image Guidance in Common Spine Interventional Procedures for Pain Management: A Comprehensive Narrative ReviewMartina Rekatsina0Philip W. H. Peng1Department of Anesthesia and Pain Management, Aretaieion University Hospital, National and Kapodistrian University of AthensDepartment of Anesthesia and Pain Management, Toronto Western Hospital, University of TorontoAbstract 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.https://doi.org/10.1007/s40122-025-00731-9Image guidanceSpinal proceduresSpine injectionsSafetyAccuracyFluoroscopy |
| spellingShingle | Martina Rekatsina Philip W. H. Peng The Importance of Image Guidance in Common Spine Interventional Procedures for Pain Management: A Comprehensive Narrative Review Pain and Therapy Image guidance Spinal procedures Spine injections Safety Accuracy Fluoroscopy |
| title | The Importance of Image Guidance in Common Spine Interventional Procedures for Pain Management: A Comprehensive Narrative Review |
| title_full | The Importance of Image Guidance in Common Spine Interventional Procedures for Pain Management: A Comprehensive Narrative Review |
| title_fullStr | The Importance of Image Guidance in Common Spine Interventional Procedures for Pain Management: A Comprehensive Narrative Review |
| title_full_unstemmed | The Importance of Image Guidance in Common Spine Interventional Procedures for Pain Management: A Comprehensive Narrative Review |
| title_short | The Importance of Image Guidance in Common Spine Interventional Procedures for Pain Management: A Comprehensive Narrative Review |
| title_sort | importance of image guidance in common spine interventional procedures for pain management a comprehensive narrative review |
| topic | Image guidance Spinal procedures Spine injections Safety Accuracy Fluoroscopy |
| url | https://doi.org/10.1007/s40122-025-00731-9 |
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