E4733. Chronic Low Back Pain and the Emerging Role of the Interventional Radiologist
  1. Michael Tolkov; Saint John's Riverside Hospital
  2. Monica Lee; Lake Erie College of Osteopathic Medicine - Seton Hill
  3. Giovanni Santoro; Northwell Health - Mather Hospital
  4. Kenny Lien; Northwell Health - Mather Hospital
Low back pain (LBP) is one of the most common reasons for primary care visits. As its global prevalence increases, LBP continues to be a major contributing factor to patient disability and decreased quality of life. Interventional treatment of chronic LBP has been effective for managing symptoms, decreasing opioid requirement, and reducing patient morbidity. These interventions are often performed by nonradiologist pain management specialists. More recently, interventional radiologists have started incorporating minimally invasive interventional pain procedures into their practices. Interventional radiologists are well-suited to deliver high quality care to these patients given their imaging expertise and unique procedural skillset.

Educational Goals / Teaching Points
Provide an overview of LBP and discuss treatment strategies. Review the anatomy of the vertebral column and its pain generators. Discuss various diagnostic and therapeutic minimally invasive interventions for managing chronic LBP.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
There are multiple pain generators within the spine that can be targeted by the interventional radiologist. We will provide a brief overview of the various etiologies of chronic LBP including radicular pain, facet joint pain, discogenic pain, vertebrogenic pain, spinal stenosis, and sacroiliac joint dysfunction. For each pain generator, we will review the relevant anatomy, physical examination findings, imaging characteristics, and provide a technical summary of image-guided interventions. These treatment options include epidural spinal injections, medial branch nerve block and ablation, basivertebral nerve ablation, intradiscal injections, interspinous spacer placement, and sacroiliac joint injection and fusion.

Given the interventional radiologist’s imaging expertise and the increasing role of interventional radiology as a primary clinical specialty, interventional pain management is well within the scope of interventional radiology practice. As the prevalence of chronic LBP continues to rise, interventional radiologists are well equipped to treat this growing population. Interventional radiologists are capable of delivering high quality minimally invasive image-guided treatment of LBP, thereby reducing patient morbidity and the need for more invasive surgical management.