Spine Injections for Persistent Lumbar and Radicular Pain After Lumbar Spine Surgery

The goal of this chapter is to inform the reader about the most common spine injections currently used to diagnose and treat post-lumbar surgery syndrome (PLSS). Due to the influence of payors and policymakers on surgical decision-making, PLSS will also be briefly presented within an epidemiologic, historic, and socioeconomic context. Payors, policymakers, researchers, and other stakeholders have sounded an “alarm” over the increase in spine surgeries. They have sounded the same alarm over the proliferation of interventional procedures in nonoperative spine practices. Detractors argue that some of these procedures are dubious, risky, and scientifically unproven and do not lead to long functional improvement. Some interventions have stood the test of time, e.g., epidural injections, diagnostic facet and sacroiliac joint blocks, and medial branch neurotomy, but other treatments such as pulsed radiofrequency treatments of spinal nerves or various intradiscal therapies are recent interventions and may or may not be in common use in the future. With the meteoric rise in spine injections over the last decade, often without appropriate indications, spine interventionalists have come under intense scrutiny to justify the medical necessity of their procedures. Ultimately, both patient and the physician are the losers with performance of medically unnecessary spine injections. Because spine interventionalists did not utilize rigorous indications for successful diagnostic and therapeutic interventions in the last decade, payors and policymakers intervened.