Artificial Intelligence for Procedural Guidance of Spinal Epidural Steroid Injections: A Scoping Review

Area of Science:

• Medical Imaging and Interventional Radiology
• Artificial Intelligence in Medicine
• Spinal Interventions

Background:

• Spinal epidural steroid injections (SESI) are common for radiating pain but face challenges with precision and outcomes.
• Artificial intelligence (AI) is being explored to improve medical procedures, including SESI.

Purpose of the Study:

• To conduct a scoping review summarizing current evidence on AI's role in guiding SESI procedures.
• To identify AI applications in pre-procedural planning, intra-procedural guidance, and post-procedural outcome prediction for SESI.

Main Methods:

• Searched PubMed, Web of Science, and Embase for English-language primary studies from 2015-2025.
• Included nine studies utilizing AI architectures like machine learning and deep learning.
• Categorized evidence into pre-procedural planning, intra-procedural guidance, and outcome prediction.

Main Results:

• Most studies showed AI improved trajectory planning, needle localization, segmentation, and predictive performance.
• Potential benefits include reduced procedure time, lower radiation exposure, and better patient selection.
• Limitations include model dependency, small datasets, and underrepresentation of certain patient groups.

Conclusions:

• AI demonstrates significant potential to enhance the guidance and outcomes of SESI.
• Further large-scale, standardized research is necessary before routine clinical implementation.
• AI may optimize patient selection and procedural efficiency in SESI.