LAUSR

Image guided anaesthetic blocks play an increasing role in the diagnostics as well as the treatment of spinal disorders. In the workup of many painful conditions, especially degenerative disorders, they are able to add a valuable piece of the puzzle. While patient’s history, physical examination and numerous imaging modalities still make up the core in diagnosing spinal disorders, the specific assessment of the clinical value of individual findings often proves to be difficult. While a number of studies has also shown the limits of the validity and reliability of image guided injections, they are still widely used especially in multi-segmental disease [1, 6]. In the framework of diagnostics, image guided injections to the lumbar spine or the cervical spine make up a valuable piece in the diagnostic puzzle [3]. In the therapeutic setting, however, injections play a significant role in treating joint pain, radicular pain and spinal pain of discogenic origin. When performing image guided injections to the spine it is highly important to follow a very standardized and proven protocol for pre-procedural planning, positioning, setup and monitoring, X-ray control, needle positioning, injected substances and postprocedural surveillance as well as documentation. The guidelines by the SIS may provide a valuable framework in this regard [2, 4, 5]. In the current film two injections are shown. In the first, a therapeutic lumbar epidural injection in the level L4/5 through an interlaminar approach is shown. The second film shows a cervical periarticular facet joint injection through a posterior approach. Both injections are done in a specific injection suite fitted with a carbon fibre table designed for image-guided interventions and with use of a C-arm. Both patients have been selected out of the pool of regular patients scheduled for injections on the day of filming. All have signed a written consent form, their lab results with regards to haemostasis, infection, thyroidas well as kidneyconditions have been checked prior to the injection. As for these specific patients, both are part of an inpatient injection protocol.