spinal interventional procedures

spinale Interventionen
spinal interventional procedures

Back pain is a common condition that is often difficult to treat. Lumbar degenerative facet joints, lumbar disc disease and sacroiliac joint pain account for nearly 70% of cases of lower back pain.

Unfortunately, as the incidence of degenerative changes in the spine is so high (e.g. disc abnormalities are found in 25% of individuals below the age of 60, and over 50% in those over the age of 60), it is sometimes difficult to confidently identify the cause of pain, without careful correlation with clinical findings and potentially diagnostic injections. The other role of spinal injections is to treat non-operative back pain.

Procedures include:

• sacroiliac joint injection
• facet joint injection
• spinal epidural injection
  • transforaminal epidural steroid injection
  • interlaminar epidural injection
    • cervical interlaminar epidural injection
    • lumbar interlaminar epidural injection
  • caudal epidural injection (via the sacral foramen)
• transforaminal nerve root block
• epidural blood patch
• vertebroplasty

All these procedures require precise needle tip position and therefore are performed with imaging guidance, either fluoroscopy or CT.

General contraindications

The following are general contraindications to elective spinal international procedures:

• active sepsis
• known allergy to local anesthetic/steroids/contrast agents
• pregnancy
• bleeding tendencies
• anticoagulation
• particulate steroids should be avoided in cervical spine epidural injections

Complications

Neurological complications

• intra-arterial injection can results in spinal cord or brain stem infarction
• neural compression or ischemia
• benzyl alcohol has caused necrosis and apoptosis of retinal pigment epithelial cells
• direct nerve trauma

Vascular complications

• bleeding with possible epidural hematoma requiring evacuation or resulting in weakness and other sequelae
• air embolism

Infectious complications

• infection with possible epidural abscess requiring evacuation or resulting in weakness and other sequelae
• osteomyelitis
• diskitis

Medication related complications

• repeated steroid injections may result in epidural lipomatosis
• gastritis (especially if the patient is on concurrent NSAIDs)
• intrathecal injection of steroids may result in arachnoiditis; this is mainly due to excipients such as polyethylene glycol
• decrease in diabetic control
• tachon syndrome
• allergic reaction to contrast agents
• allergic reaction to anesthetic products

Equipment

As in everything, there are many variations on this theme:

• spinal needle for deep injection (typically a 22G or 25G)
• skin needle for local anesthetic
• local anesthetic to skin and superficial structures, e.g. lidocaine 1% or 2%
• therapeutic injection
  • local anesthetic, e.g. bupivacaine 0.2% to 0.5%, 1-2 mL
  • steroid approved for epidural injection, e.g. dexamethasone

Siehe auch:

• epidurale Lipomatose
• epidurales Hämatom
• chronisch adhäsive Arachnopathie
• Vertebroplastie
• lumbar disc disease
• facet joint injection
• caudal epidural injection
• periradikuläre Therapie
• Gelenkinjektionen sakroiliakal
• spinal epidural injection (CT) inter laminar
• spinal epidural injections
• Infiltration Costotransversalgelenk
• Infiltration Costovertebralgelenk

und weiter:

• spinal epidural injection
• musculoskeletal