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

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.

Ultrasound‐guided L5/S1 intradiscal needle placement using biplanar approach with the patient in the lateral decubitus position: A report of three cases

“…In that case report, the prone position restricted the position of the transducer, and the needle trajectory was obliged in the parasagittal plane through the erector spinae muscle. As a result, the trajectory of the needle was not well visualized due to the presence of the articular process, and only the needle tip could be visualized when the needle was in its final position 1 . In the current case series, we reported a biplanar technique performed with the patient in a lateral position.…”

“…As a result, the trajectory of the needle was not well visualized due to the presence of the articular process, and only the needle tip could be visualized when the needle was in its final position. 1 In the current case series, we reported a biplanar technique performed with the patient in a lateral position. With this technique, the trajectory of the needle could be seen clearly on 2 different planes of the US from the skin entry to the needle tip inside the annulus fibrous (AF).…”

“…Most image‐guided intradiscal injection techniques described to date are performed under fluoroscopy guidance. A recent report described the use of ultrasound (US)‐guided intradiscal injection with the patients lying in the prone position 1 . However, many patients are physically incapable or have a phobia of lying in the prone position.…”

Intradiscal injection for the management of low back pain

“…Usually, this procedure is performed under imaging guidance such as real‐time multiplanar fluoroscopy and computed tomography (CT), to improve the success rate and reduce adverse events. Recently, the use of ultrasound for guiding intradiscal injection has made this procedure more convenient, safer, and decreased the physical load and radiation exposure 15,16 …”

“…Recently, the use of ultrasound for guiding intradiscal injection has made this procedure more convenient, safer, and decreased the physical load and radiation exposure. 15 , 16 …”