Journal List > J Korean Med Assoc > v.49(8) > 1080674

J Korean Med Assoc. 2006 Aug;49(8):674-681. Korean.
Published online August 31, 2006.
Copyright © 2006 Korean Medical Association
Interventional Treatment of Low Back Pain
Sang Chul Lee, MD
Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Korea. Email:

Low back pain remains one of the biggest resource-consuming problems in medicine. At least 40% of the US population at one time or another will utilize medical resources for the treatment of low back pain. Multiple percutaneous and minimally invasive interventional techniques to treat moderate to severe back pain have recently been introduced, and they can be incorporated as part of the treatment planning or the diagnostic work-up process based on the response to them. When conventional treatment fails to provide satisfactory pain reduction and improvement of the quality of life, interventional techniques can be considered. Before starting any interventional treatment, a working diagnosis needs to be developed based on the patients' history, physical examination findings, and a review of objective studies. A careful selection of patients may significantly improve the success rate of these procedures.

Keywords: Interventional treatment; Low back pain

1. Leonardo K, Joshua G. Interventional pain management: when/what therapies are best for low back pain. Current Opinion in Anaesthesiology 2005;18:569–575.
2. Raj PP. In: Practical management of pain. 2nd ed. Year Book Medical Publishers; 1992. pp. 818-820.
3. Bonica JJ, Backup PH, Anderson CE. Peridural block, an analysis of 3637 cases. Anesthesiology 1957;18:723–784.
4. Swerdlow M, Sayle-Creer W. A study of extradural medication in the relief of the lumbosciatic syndrome. Anaesthesia 1970;25:341–345.
5. Benzon HT. Epidural steroid injection for low back pain and lumbosacral radiculopathy. Pain 1986;24:277–295.
6. Abraham SE, Stephen E. Treatment of lumbosacral radiculopathy with epidural steroids. Anesthesiology 1999;91:1937.
7. Manchikanti L, Boswell MV, Singh V, Pampati V, Damron KS, Beyer CD. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskelet Disord 2004;5:15.
8. Nikolai B. International spinal injection society guidelines for the performance of spinal injection procedures: part 1: zygapophysial joint blocks. Clin J Pain 1997;13:285–302.
9. Deer TR, Timothy. Injections for the diagnosis and treatment of spinal pain. Anesthesiology 2004;32:53–59.
10. Daniel RK, Yuming Y, Louis G, Keith HB, Lawrence GL, Carl L, et al. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain: A prospective, randomized, controlled, double-blind study. J Bone Joint Surg Am 2000;82:1589–1593.
11. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints. Pain 1994;58:195–200.
12. van Wijk RM, Geurts JW, Wynne HJ. Radiofrequency denervation of lumbar facet joints in the treatment of chronic low back pain: a randomized, double-blind, sham lesion-controlled trial. Pain Practice 2006;6:147.
13. Sluijiter ME, Cosman ER, Rittman WA, Van Kleef M. The effects of pulsed radiofrequency fields applied to the dorsal root ganglion. Pain Cilinic 1998;11:109–107.
14. Stolker RJ, Vervest AC, Groen GJ. The management of chronic spinal pain by blockades: a review. Pain 1994;58:1–20.
15. Devulder J, Bogaert L, Castille F, Moerman A, Rolly G. Relevance of epidurography and epidural adhesiolysis in chronic failed back surgery patients. Clinical Journal of Pain 1995;11:147–150.
16. Igarashi T, Hirabayashi Y, Seo N, Saitoh K, Fukuda H, Suzuki H. Lysis of adhesions and epidural injection of steroid/local anaesthetic during epiduroscopy potentially alleviate low back and leg pain in elderly patients with lumbar spinal stenosis. British Journal of Anaesthesia 2004;93:181–187.
17. Saal JA, Saal JS. Intradiscal electrothermal treatment for chronic discogenic low back pain: a prospective outcome study with minimum 1-year follow-up. Spine 2000;25:2622–2627.
18. Kleinstueck FS, Diederich CJ, Nau WH, Puttlitz CM, Smith JA, Bradford DS, et al. Acute biomechanical and histological ef fects of intradiscal electrothermal therapy on human lumbar discs. Spine 2001;26:2198–2107.
19. Chou LH, Lew HL, Coelho PC, Slipman CW. Intradiscal electrothermal annuloplasty. Am J Phys Med Rehabil 2005;84:538–549.
20. Nakano M, Hirano N, Ishihara H. Calcium phosphate cement leakage after percutaneous vertebroplasty for osteoporotic vertebral fractures: risk factor analysis for cement leakage. J Neurosurg Spine 2005;2:27–33.
21. Lieberman IH, Dudeney S, Reinhardt MK, Bell G. Initial outcome and efficacy of 'kyphoplasty' in the treatment of painful osteoporotic vertebral compression fracture. Spine 2001;26:1631–1638.
23. Oakley JC. Spinal cord stimulation in axial low back pain: solving the dilemma. Pain Medicine 2006;7 Suppl:58–53.