Learning objectives
To provide good understanding of spinal anatomy and potential pain sources
To discuss the relative merits of various imaging modalities used to assess spinal pathology
To review with illustrated cases the imaging findings of low back pain causes
To review with illustrated cases therapeutic techniques for
low back pain cases
Background
ANATOMY
Low back refers to the lumbar spine which is curved towards the abdomen.
The major functions include twisting,
lifting and bending.
Actually lumbar spine bears more weight than cervical or thoracic spine,
supporting the weight of the entire torso.
The lower two lumbar levels (L4-L5 and L5-S1) bear the most of this weight and are therefore prone to injury and degeneration.
Spinal canal is a circumference bounded by the spinous process,
the two vertebral laminae,
the two vertebral pedicles,
the two transverse processes and...
Findings and procedure details
IMAGING
Nowadays there is a great deal of controversy raised over red or yellow flags for the imaging of low back pain (mainly acute but the controversy is extended to chronic pain andflags' indications as well).
Red flags for imaging of low back pain are clinical indicators of a potentially serious underlying condition requiring further investigation and intervention.
Red flags include:
<20 y-o,
>55 y-o
Trauma,
corticosteroid use or malignancy history
Non-mechanical pain which is not improving with bed rest
Systemic disease,
fever or weight...
Conclusion
THERAPY
Imaging-guided infiltrations: Percutaneous infiltrations are the only method not affected by any potential impairment of blood flow in the area of pathology.
As opposed to oral or parenteral drug administration,
percutaneous infiltrations provide a direct and increased concentration of the drug in the inflamed area.
Usual solution components include a long acting corticosteroid mixed to local anaesthetic.
Remember to use local anaesthetics free of paraben or phenol in order to avoid steroid flocculation.
Steroid can be used in particulate or non-particulate forms.
The particulate...
Personal information
Dimitrios K Filippiadis MD,
PhD,
MSc,
EBIR
Consultant -Interventional Radiologist
2nd Radiology Dpt,
University General Hospital "ATTIKON"
Addr.: 1 Rimini str,
12462,
Athens,
Greece
Tel.: +30 210 5831812
Fax: +30 210 5326418
E mail:
[email protected]
Alexis Kelekis MD,
PhD,
MSc,
EBIR
Ass.
Professor of Diagnostic and Interventional Radiology
2nd Radiology Dpt,
University General Hospital "ATTIKON"
Addr.: 1 Rimini str,
12462,
Athens,
Greece
Tel.: +30 210 5831806
Fax: +30 210 5326418
E mail:
[email protected]
References
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Limbucci N,
Paonessa A,
Splendiani A.
Degenerative disease of the spine.
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Am.
2007; 17(1): 87–103
2. Percutaneous therapy versus surgery in chronic back pain: how important is imaging in decision-making.
AD Kelekis,
DK Filippiadis.
Imaging in Medicine 2013; 5(2): 187-197
3. Last AR,
Hulbert K.
Chronic low back pain: evaluation and management.
Am.
Fam.
Physician 2009; 79(12): 1067–1074
4. Maus T.
Imaging the back pain patient.
Phys.
Med.
Rehabil.
Clin.
N.
Am.
2010; 21(4): 725–766 (2010)
5. Santiago FR,...