Invasive interventions for Low Back Pain

Original Editor - Mohamed A Hassanin Top Contributors - Mohamed A Hassanin and Vidya Acharya 

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Introduction

Low back pain (LBP) is a significant worldwide socioeconomic burden with immense efforts evolved to treat it invasively or conservatively. The conservative management of LBP aims to delay or avoid surgery. As a matter of fact, LBP can improve spontaneously or with conservative treatment. Cases which do not respond to treatment are candidates for surgical intervention. Invasive methods are often used instead of surgery to eliminate pain induced by spinal structure distress e.g. disc prolapse and radiculopathies.

Epidural Steroid injections

Epidural injections involve the use of a certain type of needle to place the tip inside the epidural space, situated between the ligamentum flavum and the dura mater. Typically, the epidural space is identified using the loss of resistance (LOR) technique. This technique entails advancing the needle between the spinal processes of the vertebrae and using a syringe filled with air or saline solution to continuously assess the pressure on the syringe piston. The operator can feel a change in resistance on the syringe piston when the needle reaches the epidural space after passing through the ligamentum flavum. Additionally, CT and navigation guidance can be used to quickly perform epidural injections and enable precise needle placement by visualizing of the best needle path and identification of any issues such as narrow intralaminar spaces and spinal stenosis before inserting the needle (Figure 2).