Injection studies in spinal disorders

Spinal injections have an important role in many centers in the diagnostic assessment and treatment of patient with various spinal disorders. In the literature, many studies describe the application, techniques, and potential benefit of spinal infections. It is well accepted morphologic alterations and pain correlate weakly because many imaging findings in patients with spinal symptoms can be found in asymptomatic individuals. Accordingly, one rationale for spinal injections is to provoke or eliminate pain presumably caused by the target spinal structure; this ostensibly allows a physician to make a better assessment of whether a particular morphologic alteration does or does not cause symptoms. Another rationale is to use spinal injections to support conservative treatment in patients who have from nerve root compromise, spinal stenosis, or facet joint osteoarthritis. Despite the widespread use of these spinal injections, their application is based widely on anecdotal experience and evidence that is not evidence based. We highlight the need for prospective randomized trials on the clinical efficiency of spinal injections and stress the importance for future considerations of cost effectiveness to justify their further application.Level V (expert opinion). See the Guidelines for Authors for a complete description of the levels of evidence.