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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 29

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 29. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 262 Section Patient Assessment The diagnostic accuracy of imaging studies is limited in neck and back pain The rationale of injection studies is to eliminate or provoke the patient s pain Injection studies can have a therapeutic effect However the vast majority of patients with back and neck pain present with no or only minor structural alterations e.g. disc protrusion minor nerve root compression and mild facet joint osteoarthritis . The same alterations can be found with high prevalence in an asymptomatic population 5 6 12 56 . The predictive value of MRI in diagnosing symptomatic disc alterations is therefore limited 12 . Spinal injection studies have been advocated to differentiate a symptomatic from an asymptomatic lesion because of the low positive predictive value of imaging studies 56 74 110 . The rationale for spinal injections is therefore either to provoke spinal pain or eliminate spinal pain which is presumably related to the target spinal structure. A large number of studies have accumulated in the literature which describe application techniques and potential benefits. However the lack of a clear understanding of the pain pathogenesis and therefore a missing gold standard makes it difficult to decide on the diagnostic impact of these injections 11 96 . The frequent use of spinal injections as a diagnostic tool has indicated that these injections may also have a therapeutic value. The second rationale is to use spinal injections to support non-operative treatment in patients suffering from nerve root compromise spinal stenosis or facet joint osteoarthritis. However debate continues whether the rationale for the use of spinal injections is evidence based 80 119 124 . Despite the widespread use of these spinal injections their application is widely based on anecdotal experience and at best is evidence enhanced but definitely is not evidence based. Lumbar and Cervical Nerve Root Blocks Radiculopathy is caused by a combination of mechanical compression and