The Role of Diagnostic Injections in Spinal Disorders: A Narrative Review

Abstract

Neck and back pain is increasingly prevalent, and has increased exponentially in recent years. As more resources are dedicated to the diagnosis of pain conditions, it is increasingly important that the diagnostic techniques used are as precise and accurate as possible. Traditional diagnostic methods rely heavily upon patient history and physical examination to determine the most appropriate treatments and/or imaging studies. Though traditional means of diagnosis remain a necessity, in many cases, correlation with positive or negative responses to injections may further enhance diagnostic specificity, and improve outcomes by preventing unnecessary treatments or surgeries. This narrative review aims to present the most recent literature describing the diagnostic validity of precision injections, as well as their impact on surgical planning and outcomes. Diagnostic injections are discussed in terms of facet arthropathy, lumbar radiculopathy, discogenic pain and discography, and sacroiliac joint dysfunction. There is a growing body of evidence supporting the use of diagnostic local anesthetic injections or nerve blocks to aid in diagnosis. Spinal injections add valuable objective information that can potentially improve diagnostic precision, guide treatment strategies, and aid in patient selection for invasive surgical interventions.

Limited surgery assisted by ultrasound-guided selective nerve root block for the treatment of degenerative scoliosis: a preliminary clinical report

“…This study innovatively applies SNRB to guide the development of surgical plans for degenerative scoliosis.SNRB has both diagnostic and therapeutic effects, and its bene ts in the diagnosis and treatment of radiculopathy have been reported [14,15,[29][30][31].Ko et al [32] demonstrated that the symptom improvement 6 hours after SNRB predicted the clinical e cacy 12 months after the decompression of lumbar spinal stenosis.Kanaan et al [15] showed that SNRB reduced the surgical rate of lumbar radiculopathy.…”

“…This minimally invasive procedure relieves symptoms by selectively injecting corticosteroids and local anesthetic around the dural sheath and compressed nerve roots.The application of SNRB has been reported in the diagnosis and treatment of lumbar radiculopathy, especially for the determination of the responsible segments and precise treatment of complex low back and leg pain [10][11][12]. Although the diagnosis and treatment effects of SNRB are controversial [13], most studies suggest that this minimally invasive surgery can accurately determine the responsible nerve root during diagnosis and can reduce the need for surgery in the treatment of lumbar radiculopathy [14][15].…”

Progress in Discography

“…Junhui Liu et al found that painful SN that is difficult to receive conservative treatment is an indication for discography, and their study demonstrated that discography and disco block therapy can provide rapid and durable relief of symptoms, thereby improving the quality of life of patients 44 . Discography has been proven to be a useful tool for surgical planning 45 , and the study by Xi M A et al showed that discography can accurately locate and reduce the level of lumbar spinal fusion surgery 46 , thereby ensuring the quality of surgery.…”