Image-Guided Injection Therapy in the Lumbar Spine

Abstract

Degenerative changes in the lumbar spine can cause back pain with or without radiation into the lower limb. The most common sufferers are middle-aged persons between the ages of 30 and 50, but the number of patients under age 30 is steadily rising. The affected persons typically have pain that can be treated initially with physical therapy and medications. When these measures no longer suffice, injection therapy can provide additional help. Published guidelines now recommend periradicular injection therapy for radicular lumbar syndromes. This low-risk, minimally invasive form of treatment should always be preferred over a surgical procedure unless major weakness is present (7, 14–16). Computerized tomography (CT) or conventional X-ray fluoroscopy is often used to provide imaging guidance for the placement of the injecting needle into the lumbar spine. Both of these techniques result in the delivery of a certain amount of ionizing radiation to the patient. The lumbar spine and the abdominal and pelvic organs lie unprotected in the path of the X-ray beam generated by the CT scanner or fluoroscope. Health care is an important area where measures should be taken to protect against radiation injury, because, on average, about 50% of an individual’s annual dose of ionizing radiation is derived from medical procedures (1, 2). The potentially problematic use of ionizing radiation in medicine is currently under discussion in a number of countries, not only in Germany (3, 11, 12), particularly in light of the increasing use of computerized tomography (17). The purpose of this article is to raise awareness of the problem of ionizing radiation in image-guided injection therapy.