Elective Spinal Injections
The Recommendation: Do not perform elective spinal injections without imaging guidance, unless contraindicated.
The Rationale: Elective spinal injections should be performed under imaging guidance using fluoroscopy or CT with contrast enhancement (except when contraindicated) to optimize needle placement, diagnostic accuracy, therapeutic efficacy. Not using imaging guidance may result in inappropriate, and thereby less effective, medication placement and the need for additional future care and cost.
Dr. Wei's Bottom Line: Imaging is critical to ensuring accuracy as well as a good outcome. The use of fluoroscopy or CT guidance is often preferred by spine specialists. In rheumatology, we tend to use either fluoroscopy or ultrasonography, primarily because we often don't have access to a CT unit. Specifically, we are using ultrasonographic guidance more and more, which I think is superior to fluoroscopy for 2 reasons. The first is that soft-tissue abnormalities are visible, as are major vessels; this precludes the possibility of inadvertent damage. In addition, there is no radiation with ultrasonography.
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