Guidelines to Imaging Landmarks for Interventional Spine Procedures: Fluoroscopy and CT Anatomy

Many diagnostic and therapeutic spine procedures can be performed percutaneously under fluoroscopic imaging guidance. Knowledge of radiographic and cross-sectional anatomy, together with strict adherence to procedural technique, is key for safety and success. This article reviews the fundamental principles of imaging guidance with fluoroscopy. The concepts behind the basic fluoroscopic views are discussed, including the EF and level-specific orthogonal views. Regional spine anatomy and a step-by-step approach for the most common percutaneous spine accesses are reviewed by comparing percutaneous needle access on the standard fluoroscopic views with their 3D and cross-sectional CT anatomy correlates.