Fluoroscopy-guided periradicular injections in spine

Abstract

Periradicular injection is a modality that is extensively used for diagnosing and treating nerve root pain both in the cervical and lumbar spinal regions. It offers a viable alternative to surgical management of radicular pain because of disorders of the intervertebral disks or degenerative spinal conditions. These injections usually comprise steroids and local anaesthetics. There is evidence suggesting that periradicular injections of local anaesthetic without steroids may be equally effective treatment for a select group of patients with chronic function-limiting axial or extremity pain secondary to spinal stenosis. These injections can be administered by transforaminal, interlaminar, or caudal routes with the aid of fluoroscopy or computed tomography guidance. Despite good clinical outcomes, the underlying mechanism of action of periradicular steroid and local anesthetic injections is still not fully understood. We hereby describe the technique of transforaminal periradicular injections at the lumbar, lumbosacral, cervical, and thoracic levels. The article gives an overview of essential requirements for the procedure, concepts, technical tips, and potential complications. Copyright © 2013 by Lippincott Williams &Wilkins.