TY - JOUR
T1 - Management of chronic low back pain
T2 - Rationales, principles, and targets of imaging-guided spinal injections
AU - Fritz, Jan
AU - Niemeyer, Thomas
AU - Clasen, Stephan
AU - Wiskirchen, Jakub
AU - Tepe, Gunnar
AU - Kastler, Bruno
AU - Nägele, Thomas
AU - König, Claudius W.
AU - Claussen, Claus D.
AU - Pereira, Philippe L.
PY - 2007/11
Y1 - 2007/11
N2 - If low back pain does not improve with conservative management, the cause of the pain must be determined before further therapy is initiated. Information obtained from the patient's medical history, physical examination, and imaging may suffice to rule out many common causes of chronic pain (eg, fracture, malignancy, visceral or metabolic abnormality, deformity, inflammation, and infection). However, in most cases, the initial clinical and imaging findings have a low predictive value for the identification of specific pain-producing spinal structures. Diagnostic spinal injections performed in conjunction with imaging may be necessary to test the hypothesis that a particular structure is the source of pain. To ensure a valid test result, diagnostic injection procedures should be monitored with fluoroscopy, computed tomography, or magnetic resonance imaging. The use of controlled and comparative injections helps maximize the reliability of the test results. After a symptomatic structure has been identified, therapeutic spinal injections may be administered as an adjunct to conservative management, especially in patients with inoperable conditions. Therapeutic injections also may help hasten the recovery of patients with persistent or recurrent pain after spinal surgery.
AB - If low back pain does not improve with conservative management, the cause of the pain must be determined before further therapy is initiated. Information obtained from the patient's medical history, physical examination, and imaging may suffice to rule out many common causes of chronic pain (eg, fracture, malignancy, visceral or metabolic abnormality, deformity, inflammation, and infection). However, in most cases, the initial clinical and imaging findings have a low predictive value for the identification of specific pain-producing spinal structures. Diagnostic spinal injections performed in conjunction with imaging may be necessary to test the hypothesis that a particular structure is the source of pain. To ensure a valid test result, diagnostic injection procedures should be monitored with fluoroscopy, computed tomography, or magnetic resonance imaging. The use of controlled and comparative injections helps maximize the reliability of the test results. After a symptomatic structure has been identified, therapeutic spinal injections may be administered as an adjunct to conservative management, especially in patients with inoperable conditions. Therapeutic injections also may help hasten the recovery of patients with persistent or recurrent pain after spinal surgery.
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U2 - 10.1148/rg.276065509
DO - 10.1148/rg.276065509
M3 - Review article
C2 - 18025516
AN - SCOPUS:36849072029
SN - 0271-5333
VL - 27
SP - 1751
EP - 1771
JO - Radiographics
JF - Radiographics
IS - 6
ER -