Management of Chronic Low Back Pain: Review of Fluoroscopy-Guided Epidural Steroid Injection

Chronic low back pain point prevalence in US adults ages 20‐69 years is approximately 13.1%. It is estimated that approximately 12%‐15% of visits to health care providers in the United States are related to low back pain and is considered as an economic burden, not only due to the loss of work productivity but also due to direct health care costs, with an estimated median treatment cost of approximately $13,015 per quality-adjusted life year. Even with well-selected patients, the surgical outcome in patients with low back pain may vary. Conservative management by using physical therapy and rehabilitation is considered an equally good alternative option for patients with chronic low back pain. Percutaneous minimally invasive pain-alleviating spinal procedures are helpful for patients who do not have a compelling indication for surgical intervention, who are not good surgical candidates due to their associated comorbidities, and who cannot tolerate the oral pain medications in the required doses. Percutaneous minimally invasive pain-alleviating spinal procedures are increasingly popular due to increasing patient awareness of alternative treatment options and also the skepticism about the cost-effective role of spinal surgery for pain. In this article, we provide a basic review of relevant anatomy, preprocedure assessment, and techniques for most commonly used percutaneous image-guided spinal epidural procedures and briefly discuss the potential complications.

Learning Objectives: To describe relevant spinal anatomy; to provide a brief illustration of basic techniques and approaches for spinal pain control procedures and regional anesthesia; and to discuss predisposing factors, pathophysiology, and imaging features of associated complications.