Approaches in injections for radicular pain: the transforaminal, epidural and transfacet approaches.

Spinal injections must be carried out adhering to very strict conditions. However, these procedures have almost come to be seen as everyday and may be practised under quite questionable conditions. The recent reports of new and extremely serious neurological complications have changed the attitudes of those making referrals as well as the attitudes of the interventional radiologists carrying out these procedures. The range of indications for transforaminal injections has shrunk in favour of epidural injections. Where the transforaminal approach is still used, the needle must be positioned extremely accurately. A prior radioopaque contrast medium injection is essential from a safety perspective. The transforaminal epidural injection via the transfacet approach looks to be a promising alternative that is strictly avascular.

Can low-dose computed tomographic scan of the spine replace conventional radiography? An evaluation based on imaging myelomas, bone metastases, and fractures from osteoporosis.

We evaluated and compared the radiological images of the spine of 111 patients affected by myeloma, bone metastases, and fractures secondary to osteoporosis demonstrated in low-dose computed tomographic (CT) scans and those demonstrated in conventional radiographic studies. From the analysis of the data obtained, it appears that the duration of the CT procedure is definitely shorter and that its diagnostic sensitivity is superior to that of conventional radiography. We should mention that the dose of radiation delivered by CT scanning does not constitute an unfavorable element in patients, usually elderly, for whom CT scanning was indicated.