Computed Tomography-guided Periradicular Injections on Cervical and Lumbar Spine

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Treating sciatic pain caused by intervertebral disk herniation remains challenging. Not only does the symptomatology put a strain on patients, it is also of enormous socioeconomic impact. Next to conservative measures that include physical therapy and adequate pain medication, surgery—absolutely indicated in cases of cauda syndrome and severe motor deficit—seems to be the treatment of choice. In some cases though surgery seems to have identical long-term results compared with conservative management. Yet, neither conservative measures nor surgery always provide sufficient results. Moreover, there are a number of patients who do on the one hand not respond to conservative therapy, but do on the other hand not have the indication for surgery. As a result alternative, minimally invasive, image-guided therapies, such as periradicular therapy, have been introduced in recent years. Periradicular therapy is indicated in patients with radicular pain symptoms or radiculopathy, which may be caused by foraminal or spinal canal stenosis, tumors, or spondylolisthesis, and has become popular in the treatment of lumbar radicular complaints due to disk herniation. This review article focusses on different aspects of CT-guided periradicular injections and emphasizes a selection of practical considerations of important interventions at different spinal regions.

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