Cardiovascular and Interventional Radiological Society of Europe
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Image-guided pain management – online course


Please note that this course is no longer CME accredited, but we are working on a new accredited version.

Authors: A. Kelekis and A. Ryan

Reviewers: F. Deschamps, D. Filippiadis, M. Hoffmann, S. Müller-Hülsbeck and C. Nice

This course corresponds to chapter Spinal Procedures for Disc, Nerves and Facet Joints in the European Curriculum and Syllabus for IR.



The management of spinal pain is multidisciplinary, involving interventional radiologists, anaesthesiologists, orthopaedic surgeons and neurosurgeons. The patient’s history, clinical examination and imaging findings are crucial in order to identify and treat the specific pain generators and to define patient and treatment-modality selection factors. These preceding factors are least as important as the dexterity and technical ability to perform a given procedure.

The purpose of this course is to introduce the principal image-guided approaches for spinal pain management. The procedures described below should be considered after a failure of conservative management. Whilst some of these patients may eventually require surgery, these procedures can provide significant pain relief while they await their operation.

The strengths and limitations of these techniques are thoroughly analysed in order to guide the decision-making algorithm, which is aimed at identifying the pain generators and their subsequent targeted treatment. The advances in imaging technology and instrumentation have led to the development of a series of percutaneous image-guided procedures that avoid open surgery in the majority of patients. The pivotal role played by imaging as a means of both establishing a precise diagnosis and providing a means of guidance, secures a unique and strategic role for interventional radiologists in the management of these patients.

The techniques analysed in our session include:

  • Selective nerve root blocks
  • Epidural steroid injections
  • Discography and percutaneous decompression of intervertebral discs
  • Facet joint blocks
  • Medial block/ablation for facet-mediated pain
  • Sacroiliac joint injections

In order to create a management strategy for these procedures, the anatomy and pathophysiology, the indications and contraindications of each procedure, patient preparation and techniques for treatment will be analysed.


Learning objectives

  • Appropriately identify patients with spinal pain syndrome
  • Be aware of and understand the percutaneous treatment options in these patients
  • Describe the steroids and anaesthetics used in spinal injections
  • List the absolute and relative contraindications for spinal injection, percutaneous disc procedures, facet injection and ablation, and sacroiliac injection
  • Learn the technical approaches for spinal injection, percutaneous disc management, facet block and ablation, and sacroiliac joint procedures
  • Be familiar with the subtypes (mechanical, thermal and chemical) of facet ablation and disc treatments.


Further information

This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for IR and corresponds to chapter Spinal Procedures for Disc, Nerves and Facet Joints.

The format of the course is interactive and easy to use, including texts, graphics, videos and a quiz to support your learning. The course duration is around two hours.

The enrolment period of this course is set to 90 days and may be extended throughout the year with a valid All-Access Pass.

Release date: April 2019