Introduction

Article Outline

• Copyright

Spine-related pain is a ubiquitous problem in all Western countries. It is estimated that approximately 80% of people will suffer from at least 1 episode of significant low back pain at some point in their lives. The cost of spine pain-related treatment is approaching $100 billion dollars per year in the United States alone. Conditions that are most commonly responsible for spine pain include degenerative disease, in particular the disk, nerve root, facet and sacroiliac joints, osteoporosis and related compression fracture, cancer with bone destruction or vertebral collapse, and infection.

Over the past 20 years, a broad group of image-guided spine interventional procedures have been developed that allow for effective diagnosis or treatment of many of the causes of spine pain. With careful targeting of the spine pain generator, excellent treatment outcomes can be achieved in most patients.

The radiologist, interventional radiologist, and neuroradiologist are all uniquely equipped to function as a central element in the diagnosis and treatment of these patients. Our fundamental background in advanced image interpretation, including the subtleties of spine anatomy and pathology, is a critical diagnostic tool. Insightful preprocedure image assessment coupled with the application of basic clinical spine neurodiagnostic skills enhance targeting of the patient's cause of pain. Our experience in fluoroscopic and computed tomographic guidance techniques, core elements of a radiologist's training, are critical skills required for safe and accurate spine access and treatment. Radiology departments or outpatient imaging facilities are typically equipped with the necessary spectrum of tools, including computed tomography in addition to fluoroscopy, that allow for optimization of diagnostic testing or treatment tailored to the patient and their specific clinical problem.

There are many advantages to establishing an image-guided spine interventional practice with direct involvement in the evaluation and management of spine pain patients. Understanding the unique and often focally discrete clinical presentations in these patients, despite multifocal abnormality on preprocedure imaging studies, markedly enhances the radiologist's clinical imaging correlation and interpretation skills. Building a positive relationship with referring physicians, in particular spine surgeons, is critical and successful treatment of these grateful patients is personally rewarding.

In this volume of Techniques in Vascular and Interventional Radiology, the basic clinical and technical skills required to establish an image-guided spine interventional practice are first introduced, including patient assessment along with epidural, nerve root, facet, and sacroiliac joint treatments. Progression to the more advanced techniques required for diagnosis and management are covered, including diskography and diskogenic low back pain, vertebral augmentation for osteoporotic fractures of the vertebral body or sacrum, advanced spine tumor treatment, and neurostimulation for chronic pain management. Mastering these skills will lead to safe and successful patient diagnosis or treatment and establish a platform for implementation of evolving image-guided spine intervention techniques.