Precision Injection Techniques for Diagnosis and Treatment of Lumbar Disc Disease: The Next Step

Introduction

Precision spine injections are potentially powerful tools for both diagnosing and treating the anatomic source of chronic spinal pain. While often technically challenging, with the proper training and experience these injections may be safely performed by anesthesiologists, physiatrists, radiologists, and spine surgeons. However, the critical issue is not whether needles can be safely placed precisely into various spinal structures, but rather does the result improve patient outcomes sufficiently to justify the expense associated with the procedure.

Precision injections, whether diagnostic or therapeutic, are directed towards specific spinal pathology. Identifying the specific pathology responsible for pain is often difficult, leading to frustrated patients and clinicians. If there is a clear relationship between pathology and pain, a precision injection of the affected anatomic structure may be indicated for therapeutic purposes. However, there is a high incidence of anatomic abnormalities in asymptomatic individuals, and painful individuals may have normal anatomy, at least as demonstrated on conventional imaging studies. If the relationship between spinal pathology and pain is not clear, precision diagnostic injections may be useful.