Comparing CT-guided and fluoroscopic-guided interventions for chronic low back pain management: a randomized trial

Abstract Objective Low back pain (LBP) is a leading cause of disability, with radicular symptoms often resistant to conservative treatments. While fluoroscopy and computed tomography (CT) play a pivotal role in procedural accuracy, direct comparisons of clinical outcomes remain limited. We compared the efficacy and safety of fluoroscopy— versus CT-guided interventions in the management of radicular LBP. Materials and methods Adults with chronic LBP were prospectively randomized 1:1 to receive either fluoroscopy-guided or CT-guided interventions. Assessments were conducted at baseline, one week, one month, three months, and six months, and included the visual analog scale (VAS) for pain and the Oswestry disability index (ODI) for functionality. Operative time, radiation exposure, complication rates, and patient satisfaction were evaluated. Results Two hundred participants (mean age 51.3 years) were enrolled. Baseline median VAS value was 6.0 in both groups. No significant differences in ODI were observed at any time point. However, VAS values favored fluoroscopy at one ( p  = 0.030), three ( p  = 0.041), and six months ( p  = 0.012). Both groups demonstrated within-group improvements ( p  < 0.001). Radiation exposure (median 352 versus 347.5 mGy; p  = 0.970), operative time (median 22.5 versus 23 min; p  = 0.317), complication rates (96‒99% no complications), and satisfaction levels (≥ 90% satisfied or very satisfied) were similar. Conclusion Both fluoroscopy- and CT-guided interventions are safe and effective for managing radicular LBP. Fluoroscopy offers modest advantages in short-term pain relief, while CT provides enhanced anatomical visualization. The choice of imaging guidance should be individualized based on patient characteristics and resource availability. Relevance statement Fluoroscopy- and CT-guided interventions offer safe, effective, and tailored treatment options for radicular LBP, supporting personalized, image-guided approaches. Key Points Both fluoroscopy-guided and CT-guided interventions significantly improve chronic radicular LBP, but fluoroscopy provides superior short-term pain relief. Fluoroscopy and CT interventions are equally safe, with comparable complication rates, radiation exposure, and procedure durations. Selection between fluoroscopy and CT should be based on individual patient needs, procedural goals, and available resources. Graphical Abstract