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Category Archives: Spinal Injection

Spinal pain, especially low back pain (5% incidence and 60% to 80% lifetime prevalence in the United States), is very common (1). Low back pain is the leading cause of disability in people younger than 45 years. Although spinal pain often improves and resolves, a significant proportion of patients have ongoing symptoms and pain recurrence. Low back pain is a costly disorder with an annual cost approaching $50 billion (1). Therefore, a comprehensive rehabilitation approach that improves outcomes for patients with spinal pain can have a significant positive medical and economic impact. Adequate pain control can minimize disability, maximize function, improve quality of life, and potentially improve long-term outcomes by preventing the development of chronic pain syndromes. Spinal injection procedures have become an integral part of comprehensive rehabilitative management for individuals with spinal pain. Judicious use of these interventional procedures on carefully selected patients can provide optimal pain control, reduce disability, and improve functional outcome. This chapter is intended to discuss common spinal interventional procedures in an evidence-based manner and provide some instruction on performance of these procedures.

Caudal Lumbar Epidural Injections

Caudal lumbar epidural injections are performed by inserting a needle through the sacral hiatus into the epidural space at the sacral canal (Figs. 68-9 and 68-10). The patient is placed in a prone position. The legs are slightly abducted and feet turned inward to separate the gluteal fold to facilitate palpation of the sacral cornu. […]

Transforaminal Epidural Injection

Comment In one systematic review comparing transforaminal, interlaminar, and caudal ESIs, the authors concluded that there was moderate evidence for long-term (>6 weeks) relief of lumbar radicular pain using the transforaminal and caudal approaches, but limited evidence using the interlaminar approach (30). The authors also concluded that there was moderate evidence for relief of cervical […]

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