Interventional Therapy: Avoiding Complications From Interventional Spine Techniques
by Richard M. Rosenthal, MD; Denice Starley, DO; and Chad Austin, MD
 Residency training in
the field of interventional pain medicine does not currently exist. While there are
fellowship programs, they differ significantly in their approaches to teaching spinal
interventions. Thus, there is no universally accepted means of gaining competency in the
specialty, nor is there is an agreed upon standard of knowledge that interventional pain
physicians must possess. While board exams do exist, none are ACGME-accredited and there
is no requirement to sit for them.
Physicians enter the field of interventional pain medicine with divergent knowledge
gained from their primary specialties. However, knowledge and training in interventional
techniques are acquired by varied means.1 Some learn from experienced,
well-qualified practitioners during a fellowship year. Others learn by observing or taking
a weekend course. Still others enter the field with little more training than having read
a textbook. When performing procedures, there is usually no trained observer in the
procedure suite. This means that the operator is free to do whatever he or she thinks
best. Given this, and the fact that there is as yet no standardized body of knowledge
required for the field, it falls to the physicians themselves to possess the knowledge and
abilities necessary to provide the standard of care expected of a well-trained physician.
Individual physicians must police themselves as to their competency and qualifications for
safe practice. Unfortunately, it appears that often this is not the case. Over the last
several years, the number of interventional procedures performed has risen dramatically,
as has the number of malpractice claims.2,3 A consistent theme in these cases
is that prescribed protocols have not been followed or correct techniques have not been
used.4
Interventional pain specialists, recognizing these difficulties, have begun taking
steps to address them. Professional societies such as ISIS and ASIPP have written
guidelines and protocols that provide recommendations for proper procedure performance and
avoiding possible complications. Additionally, the ISIS guidelines were recently
supplemented by an excellent review of complications from spinal procedures published by
Bogduk et al.4 The article reviews correct surgical technique and recommends
ways to avoid complications. The aim of this article is to further supplement the
literature available in the field and to provide information on how to identify and avoid
common risks associated with spinal injections.
Please refer to the March 2010 issue for the complete text. In the event you need to order a back issue, please click here.
— March 2010
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