الفهرس 
Anatomy of lumbar plexus, facet joint, sacroiliac joint.Only 14 pages are availabe for public view
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Abstract
Summary and conclusion
Low back pain is one of the most frequently reported symptoms in the industrialized world (Luo et al 2004).
In most cases, the symptom is due to a benign condition involving some degree of
spinal degeneration . Pain that continues for more than 7–12 weeks despite conservative management is described as chronic (Andersson et al 1999).
The estimated prevalence of nonspecific chronic low back pain in adults is 15% but increases with increasing age, to 44% at the age of 70 years (Manchikanti et al 2002).
If low back pain does not improve with conservative management, the cause of the pain must be determined before further therapy is initiated.
Information obtained from the patient’s medical history, physical examination, and imaging may suffice to rule out many common causes of chronic pain (eg, fracture, malignancy, visceral or metabolic abnormality, deformity, inflammation, and infection).
However, in most cases, the initial clinical and imaging findings have a low predictive
value for the identification of specific pain-producing spinal structures.
Diagnostic spinal injections performed in conjunction with imaging may be necessary to test the hypothesis that a particular structure is the source of pain. To ensure a valid test result, diagnostic injection procedures should be monitored with fluoroscopy, computed tomography, or magnetic resonance imaging. The use of controlled and comparative injections helps maximize the reliability of the test results.
After a symptomatic structure has been identified, therapeutic spinal injections may be administered as an adjunct to conservative management, especially in patients with inoperable conditions. Therapeutic injections also may help hasten the recovery of patients with persistent or recurrent pain after spinal surgery.(Fritz et al 2007).
Spinal injections may be performed to obtain functional information about a putative pain generator and are widely used also for the management
of chronic low back pain (Fritz et al 2007).
A meticulous adherence to basic concepts and principles based on current knowledge helps maximize the accuracy of the injection result. Spinal injection procedures may be best understood as an additional tool for the evaluation and treatment
of chronic low back pain, with low risk-benefit ratios and relatively low costs. When the information obtained from such procedures is considered in combination with information from the patient’s medical history and non interventional
imaging and clinical examinations by an experienced multidisciplinary group of orthopedic surgeons, radiologists, neurosurgeons, anesthesiologists,
psychiatrists, and physiotherapists, the result is a more directed and patient-specific
treatment plan. (Fritz et al 2007).