Back and Neck Pain

Reducing Radiation Exposure in CT Guided Injections

UCSF Radiologist Dr. Hess describes new techniques to help minimize the radiation of CT imaging for back pain.
 

Two general approaches to using imaging

  • X-ray fluoroscopy-uses bony landmarks, assume location of relevant soft tissues
  • CT-visual and target soft tissues
  • Downside of CT-higher radiation dose to patient

Radiation Dose and CT guidance

The Role of Spine Injections

 
Image-Guided Spine Injections
  • Reduction of pain and inflammation (NSAIDs)
  • Permit physical therapy
  • Improve quality of life
  • Delay (or  obviate) surgery

Spine injections

Addressing Back Pain

Disc herniation: upon rupture, a portion bulges out from between the vertebrae, pinching nerves.
 

What fraction of back pain is caused by disk herniation?  4% of less

Causes for Back and Neck Pain 

The Prevalence of Back Pain

UCSF Radiologist Dr. Hess describes how common back pain is one of the primary medical issues in the country.
 

Epidemiology of Back and Neck Pain in the US

The Role of Spinal Interventions

Message

By integrating patient history, clinical examination, and imaging findings.  CT-guided injections: Provide effective treatment for certain types of back pain, increase specificity in back pain diagnosis, and enhance precision and safety in spine interventions.

Organization

Precision Spine Moving Forward

UCSF Radiologist Dr. Dillon goes over what to expect from precision procedures in the future.
 

UCSF CT guided spinal injections

Visualizing Other Causes of Back Pain

UCSF Radiologist Dr Dillon: Understanding how CT Scanners can help pin point other causes of lower back pain for a more precise diagnosis.
 

CT allows opportunity to visualize other causes of pain at time of injection. Integration of history, physical examination and imaging is a very powerful tool. Doctors would see the patient, examine the patient, scan the patient, and sometimes even put BB on where the patient’s pain.

Facet Disease: An under-appreciated Cause of Lower Back Pain

Common procedures

  • Nerve Root block (radiculitis)
  • Transforaminal epidural
  • Inter laminar epidural
  • Facet and or medial branch block (facets)
  • RFA for facet arthropathy

Facet Arthropathy

Safety Considerations for Spinal Injections

UCSF Radiologist Dr. Dillon goes over a list of important issues to keep in mind when performing a spinal injection. He also shares a couple non-UCSF cases where these considerations were ignored.
 

Selective Nerve Root Block Complications

Advantages of CT Guided Injections

UCSF Radiologist Dr Dillon describes the use of CT-image guided injections not only allow for precise positioning at the time of the injections but also for more effective injections at harder to reach places.

Outcomes of this technique and one study SNRB/ESI Outcomes Results

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