Image-Guided Injections for Low Back Pain: Focus on Computed Tomography Fluoroscopy

Mark P. Bowes, PhD

*Medical Writer, Portland, Oregon

Address correspondence to: Mark P. Bowes, 7135 SE 18th Ave, Portland, OR 97202. Ph: 503.224.1414; email:

Disclosure statement: Dr Bowes reports having no financial or advisory relationships with corporate organizations related to this activity.



Approximately 80% of adults in the United States experience low back pain at some point during their lifetimes. Although back pain is often self-limited and improves with rest or conservative medical management, many patients experience chronic or recurrent pain. Clinical practice guidelines from the American College of Physicians, the American Pain Society, and the American Academy of Radiology do not recommend routine imaging for the assessment of back pain, although imaging is recommended for patients when the history or physical examination suggest the presence of severe neurologic deficits or other "red flag" signs or symptoms that suggest serious underlying problems. Injections of corticosteroids and/or analgesics into the lumbar spine have long been used to relieve back pain and to identify spinal nerves that contribute to low back pain. Although epidural and facet joint injections may be performed using surface anatomic landmarks, these "blind" injections result in incorrect needle placement in a substantial proportion of cases. Fluoroscopy, computed tomography (CT), and CT fluoroscopy (CTF) provide more accurate needle placement, with improved diagnostic yield and pain relief in patients undergoing lumbar spine procedures. CTF combines the high resolution of conventional CT scanning with real-time needle guidance and may be performed using radiation exposure levels that are comparable to those of other x-ray imaging techniques. Although image-guided lumbar injections are associated with a very low risk of serious adverse events, clinicians should be aware of potential safety issues associated with these procedures, including the potential for very rare but serious neurologic events. Radiologic technologists should also be able to counsel patients about preparing for image-guided lumbar spine procedures, and to help establish reasonable expectations about the timing and magnitude of pain relief with these procedures.    

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