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Ultrasound-Guided Lumbar Intradiscal Injection for Discogenic Pain: Technical Innovation and Presentation of Two Cases

Authors Wu TJ, Hung CY, Lee CW, Lam S, Clark TB, Chang KV

Received 9 March 2020

Accepted for publication 1 May 2020

Published 19 May 2020 Volume 2020:13 Pages 1103—1107


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Robert B. Raffa

Supplementary video 1 of "US-guided lumbar intradiscal injection for discogenic pain" [ID 253047].

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Tsung-Ju Wu,1,2 Chen-Yu Hung,3 Chih-Wei Lee,4 Stanley Lam,5 Thomas B Clark,6 Ke-Vin Chang3

1Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan; 2Department of Physical Medicine and Rehabilitation, Yuanlin Christian Hospital, Changhua, Taiwan; 3Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; 4Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan; 5Department of Family Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; 6Private Practice Ultrasonographic Training, Vista, CA, USA

Correspondence: Chen-Yu Hung
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan

Abstract: We described two cases and the techniques for using the ultrasound (US) to guide lumbar intradiscal injection with platelet-rich plasma (PRP). The two cases suffered from chronic low back pain. Magnetic resonance imaging revealed posterior annular tear of the L5/S1 intervertebral disc (IVD) in the first case and L4/5 and L5/S1 IVDs in the second case. For the US-guided lumbar intradiscal injection, the patient was placed in a prone position. By placing the transducer in the axial plane at the interlaminar space, the needle was directed toward the center of the aimed IVD. The needle tip was ensured inside the IVD by using the end-feel of sudden reduction of resistance and the poking technique with the transducer oriented in the paramedian sagittal oblique plane. At the follow-up, both patients had significant improvement after the intradiscal PRP injections (visual analogue scale from 7.5 to 1.5 on average). The report indicated US-guided lumbar intradiscal PRP injection to be a feasible approach for treatments of low back pain. Familiarization of the anatomy and sonoanatomy of the lumbar spine is fundamental to achieve the success of intradiscal injection.

Keywords: low back pain, lumbar spine, ultrasound, platelet-rich plasma, intervertebral disc

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