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The joint is usually injected from the extensor surface at a point where the synovium is closest to the skin. This site minimizes the interference from major arteries, veins, and nerves. When the point of injection has been determined, it is best marked with the tip of a retracted ballpoint pen or a needle hub by pressing the skin to produce a temporary indentation to mark the point of entry. The skin is then prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure.

Spinal pain, especially low back pain (5% incidence and 60% to 80% lifetime prevalence in the United States), is very common (1). Low back pain is the leading cause of disability in people younger than 45 years. Although spinal pain often improves and resolves, a significant proportion of patients have ongoing symptoms and pain recurrence. Low back pain is a costly disorder with an annual cost approaching $50 billion (1). Therefore, a comprehensive rehabilitation approach that improves outcomes for patients with spinal pain can have a significant positive medical and economic impact. Adequate pain control can minimize disability, maximize function, improve quality of life, and potentially improve long-term outcomes by preventing the development of chronic pain syndromes. Spinal injection procedures have become an integral part of comprehensive rehabilitative management for individuals with spinal pain. Judicious use of these interventional procedures on carefully selected patients can provide optimal pain control, reduce disability, and improve functional outcome. This chapter is intended to discuss common spinal interventional procedures in an evidence-based manner and provide some instruction on performance of these procedures.