Seeing is Believing
Image guided pain injections
The first use of spinal injections for pain dates back to 1901. That’s when researchers injected cocaine just above the tailbone to help relieve lower back pain. The first report of epidural steroid injection for back pain was in 1952; that’s when researchers injected the steroid hydrocortisone into the epidura – the space that surrounds the spinal cord – of the lower back. pain injection
Today, epidural injection of steroidal painkillers is commonly used to treat difficult problems with lower back pain, sciatica and other joints. According to radiologist Kenneth Salce, M.D., of Northern Arizona Radiology, advanced imaging for the accurate placement of the needle and pain medication injection near the spinal cord is particularly important and is now standard practice in interventional radiology.
For spinal procedures, radiologists at the Flagstaff-based imaging center use a procedure called CT fluoroscopy to help accurately guide a specialized needle into the epidural space. A small amount of contrast material is then delivered through the needle. This helps ensure needle placement is correct for the most accurate delivery of the steroid medication into the epidural space to treat the patient’s pain.
“Before advanced imaging, physicians had to rely solely on their sense of feel or a change in pressure to determine when they reached the epidural space with the needle,” explained Salce. “We call these ‘blind’ or ‘non-guided’ injections, and they present several serious dangers to the patient, including puncture of the spinal cord and delivery of the pain killer to the wrong location, which can result in major complications such as inflammation and debilitating pain.”
Image-guided epidural injections give radiologists and technologists the safest, most accurate imaging possible, and ensure painkillers get to the right place to do their job. According to Salce, problems with image guided CT fluoroscopy are extremely rare.
“CT guidance for these kinds of procedures is much safer than non-guided,” said Salce. “Current research demonstrates blind injections for the lower back can result in needle placement outside the epidural space in approximately 25 percent of procedures.”
In addition to being dangerous, Salce said placement of the needle outside the epidural space delivers the drug to the wrong location, defeating the purpose of the entire procedure in the first place.
The most common procedures using imaging guidance at NAR include:
- epidural steroid injections for back pain (epidural injections are placed in a space that surrounds the spinal cord)
- epidural steroid injections for sciatica, a type of nerve pain in the lower back and legs
- spine facet joint injections for lower back pain (facet joints allow your back to twist and bend)
- joint injections for the shoulder, hip, elbow and ankle
Dr. Salce recommends that patients always check with their physician, hospital or imaging facility about image guided procedures before their scheduled appointment.
Kenneth V Salce, M.D.
Board certified radiologist practicing diagnostic and interventional radiology in Flagstaff, Arizona. Dr. Salce attended the University of Southern California, School of Medicine and completed his training at UCLA/Harbor General Hospital and Los Angeles County/USC Medical Center.
Dr. Salce has developed an active interventional radiology practice including the treatment of arterial and venous vascular disease. He is an active member of the Society of Interventional Radiology and acts as a medical consultant for W.L. Gore & Associates.