The utilization of spinal interventional pain techniques has grown rapidly over the last
decade. However, practitioners use widely different techniques in these procedures,
particularly in the use of image guidance. The importance of image guidance was
highlighted by the fact that in recent systematic reviews on therapeutic effectiveness
of epidural steroid injections and facet joint interventions, only studies that used image
guidance were included. The choice of image guidance remains a matter of physician
preference with conventional fluoroscopic or Computed Tomography (CT) guidance
most common.
There are many advantages to CT guidance for certain spinal interventional pain
procedures, mainly due to increased needle tip positioning accuracy. CT guidance
provides greater anatomical detail that facilitates accurate needle trajectory planning,
monitoring and final placement. Unlike conventional fluoroscopy that may be hindered
by tissue overlap and lack of surrounding anatomical detail CT guidance offers direct
visualization of the entire needle trajectory and the surrounding soft tissue and bone
structures. Large osteophytes and adjacent vascular structures can be identified and
safely avoided.
The goals of this narrative review are to provide a basic overview of CT techniques
available for spinal interventional pain procedures, to discuss the potential advantages
and disadvantages of CT guidance, to provide a simple step-by-step approach to use
of CT guidance, to share technical pearls, and to discuss methods to avoid potential
pitfalls. This review will provide interventional pain physicians with knowledge of
relevant CT image acquisition techniques and appropriate radiation dose reduction
strategies. This will contribute to increased technical success rates while reducing
radiation dose to the patient and staff.
Key words: Computed tomography, fluoroscopy, analgesia, epidural injection, spinal
injection, back pain, safety
Comparison between Computed Tomography & Fluoroscopy Guided Facet Joint Block in Lumbar Spine
