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

Abstract

Background The use of ultrasound (US)‐guided intradiscal injection has been described in the literature with the patient lying in the prone position; however, many patients are unable to lie in the prone position. Therefore, we describe an innovative technique of US‐guided platelet‐rich plasma (PRP) administration in the lumbar intervertebral disc (IVD) of 3 patients with chronic lower back pain who failed to improve with conservative management. Case Series For all the 3 patients, magnetic resonance imaging showed annular tears of the L5/S1 IVD with broad‐based central posterior protrusions. PRP injection was performed with the patients in the lateral decubitus position or modified recovery position. With the transducer initially placed in the short axis to the lumbar spine, the needle was inserted in‐plane to the IVD, with the needle trajectory clearly visualized. Once the needle entered the annulus fibrosus, placement of the needle was confirmed by turning the transducer along the long axis of the spine to validate the location of the needle tip inside the IVD. Discus stimulation was performed with contrast administered to elicit each patient’s usual pain, and spread of the contrast was confirmed under fluoroscopy. Upon confirmation of the intradiscal location, 3 ml of PRP was administered. Conclusions This report described a novel technique demonstrating that US‐guided lumbar intradiscal needle placement for PRP administration in patients lying in the lateral decubitus position is feasible.

Ultrasound-Guided Lumbar Intradiscal Injection: A Case Report With a High-Resolution Ultrasound Image

“…This presented technical challenges and posed a potential risk of nerve root injury. Lam et al reported a technique that approaches the disc more laterally compared to the earlier study [6]. However, their report was limited to injections in the intervertebral disc between the fifth lumbar vertebra and the sacrum.…”

“…A study following a group of lumbar disc herniation cases over 13 years indicated that 14% of cases treated conservatively progressed to surgery, suggesting that intradiscal injections may be performed in at least an equivalent or greater proportion [4]. Intradiscal injections are typically performed under fluoroscopy, and reports of intradiscal injections under ultrasound guidance are extremely rare [5,6]. We report a case in which we performed a new method of intradiscal injection under ultrasound guidance for lumbar disc herniation.…”

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 …”

“…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 The common medications used for intradiscal injection include oxygen-ozone (O 2 -O 3 ) mixture, steroids, methylene blue, and thermal decompression device, to reduce the inflammatory response or remove the degenerated disc by dehydration and dissolution of the NP tissues. 17 In recent years, various biological reagents and biomaterials, including platelet-rich plasma (PRP), stem cells, and hydrogel, have been used for intradiscal injection, drawing increased attention for the screening of the ideal injectable medications for IDD.…”