• Vol. 38 No. 11, 980–988
  • 15 November 2009

Computed Tomography Fluoroscopic-guided Percutaneous Spinal Interventions in the Management of Spinal Pain

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ABSTRACT

Local back pain and radiculopathy can be debilitating for sufferers of these conditions. There are a multitude of treatment modalities, ranging from conservative approaches such as bed rest, physical therapy and chiropractic manipulation, to more invasive options such as percutaneous spinal intervention (PSI) and surgery. We present here the techniques employed in the use of minimally invasive, image-guided percutaneous techniques under computed tomography fluoroscopy in our institutions. The inherent high spatial and tissue contrast resolution not only allows ease of trajectory planning in avoiding critical structures, but also allows precision needle placement. Cervical, lumbosacral, and sacroiliac pain can therefore be evaluated and treated both safely and effectively


Pain arising from the spine constitutes the majority of chronic pain disorders with the lifetime prevalence of 54% to 80%.1 Detailed history taking and physical examination, followed by correlation with imaging [such as plain radiography and magnetic resonance (MR)] remains the keystone of initial assessment and often allow localisation of pain generators. Despite advances made in imaging, however, correlation with symptomatology remains poor and most patients do not receive a definitive diagnosis, and as a result experienced continued pain, with conservative treatment remaining as the mainstay of treatment for most patients, with surgery being reserved only for the minority of cases.2

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