Ultrasound has gained recognition within the field of pain intervention owing to its definite advantage of visually localizing the specified target and additionally owing to perceived advantages of safety, accuracy, and potency. Ultrasound permits satisfactory imaging of the posterior parts of the spine and paraspinal soft tissues. Despite the introduction of newer and less consuming time’s methods with the possibility of intravascular injection, there is still insufficient clinical evidence to prove the safety of the ultrasound as a sole image guide intervention, especially for transforaminal injection. It is essential to considering safety tips and be aware of complications that are typically terribly unpleasant and cause unwanted social and legal consequence. The most important injection warnings are damage to the spinal cord and nerve roots, intravascular injection and vascular damage, loss of consciousness, paraplegia and incontinence. The object of this review article is to discuss the untoward dangerous complication which can happen after ultrasound-guided spine injections and explain how to diagnosis and manage them. Further technical and equipment advancements are needed to improve and reduce the existing limitations associated with the ultrasound-guided spine injection technique until that time the multimodality imaging guidance is safer.

Pain interventionist emphasizes particular attention to the spinal anatomy. Spine pain generators differ from intervertebral disc to facet joint or ligaments. Injection at these critical structures requires a complete visualization of anatomical location. Spinal cord injury or intravascular injections are the serious complications of spine pain intervention. Understanding the neurovascular anatomy of the spinal column prevents misfortune injection and its unwanted complications. The purpose of this study is to review spine anatomy and responsible pain generators and to verify the importance of anatomy in preventing pain injections complication.