Diagnosing and Treating Back Pain - Fluoroscopy

Fluoroscopy is a radiographic (medical imaging) technique that is used in back pain surgical procedures. Fluoroscopy for back pain procedures is an X-Ray technique that doctors use be able to see the nerve roots and soft tissues, so that they will know the exact location to deliver the injection of medicine. Fluoroscopy, unlike other types of X-Ray images which provide snapshot images of the body, takes real-time moving images of joints and areas that are about to be injected with medicine. This procedure employs the use of a fluoroscope. A fluoroscope is an X-Ray source and a fluorescent screen between which a patient is placed. During a diagnostic or treatment procedure, the patient lays either supine or upright, with a Fluoroscopy table behind them. All fluoroscopy and X-Ray procedures involve a tube that projects X-Ray photons, and an image receptor that receives these photons. Between the X-ray tube and the image receptor is the patient. As X-ray photons begin penetrating the patient, some photons are absorbed by the patient, and some are absorbed. The photons that make it through the patient and to the image receptor show up on the video and images that the, doctor can see as dark. At the areas on the image receptor where the patient absorbed a lot of photons the areas show up as white on the image. The contrasting black and white densities on the images and video provide doctors with a lot of information about the anatomy and physiology of the patient.



X-Rays and Fluoroscopy digital images, films, and video recording are good at showing clear contrasts between anatomical parts such as bones, which show up whiter, and joints and intervertebral discs, which show up as darker on the images. For organ cavities such as the digestive (GI) tract, and the soft tissues of the spine, such as the ligaments, tendons, and discs, X-Ray and Flouro alone aren't very good at showing high-quality detail. To improve the detail and contrast between the soft tissues of the spine, contrast is usually injected into the spaces to be viewed before the procedure or test is done. The injected contrast either remains in the cavity or space where it was injected, or it may move through certain structures to identify pathology such as cracks and fissures in the intervertebral discs.

The epidural injection procedure is one back related procedure where Fluoroscopy is commonly used. Epidural procedures are typically a three step process that involves:
  1. A superficial injection of an anesthetic to numb the pain for the next two injections.
  2. The injection of a contrast near the structures involved in the procedure. The radiologist will then position the Fluoroscope to get a live view of the tissue to be injected.
  3. The injection of the epidural in order to provide the patient with back pain relief.
Using the Fluoroscopy (the live X-Ray), the needle is inserted into the epidural space, which is the space between two layers of the spinal canal which houses the spinal cord. Fluoroscopy is not used in all corticosteroid injection procedures at all clinic. Nevertheless, research has shown the rate of medical errors associated with pain injections is much higher when Fluoroscopy is not used. The injection material is usually a steroid (corticosteroid) which blocks the transmission of pain signals that reach that level of the spine, from travelling up towards the pain centers of the brain.