1
|
Masuda K, Shigematsu H, Maeda M, Okuda A, Tanaka Y. Ultrasound-guided disc pain induction test for diagnosis of discogenic lumbar pain: a cross-sectional study. J Orthop Surg Res 2023; 18:847. [PMID: 37941032 PMCID: PMC10631160 DOI: 10.1186/s13018-023-04327-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Several methods can be used to diagnose discogenic pain, but only discoblock can diagnose discogenic pain definitively. This study aimed to examine the usefulness of an ultrasound-guided disc pain induction test for a simple and accurate diagnosis of the culprit lesion. METHODS We included 41 patients with lumbar pain in whom pain was induced by an ultrasound-guided disc pain induction test. All patients had confirmed pain at L1/2 to L5/S1 based on an ultrasound-guided disc pain induction test and underwent X-ray photography and magnetic resonance imaging. Seventeen patients who required injection due to severe pain underwent discoblock procedures for discs with the most intense pain, and visual analogue scale (VAS) scores were obtained before and after the procedure for these patients. We analysed the association between painful discs and radiological findings. RESULTS Pain induction was noted in a total of 65 discs, and the pain was induced in 23 patients in only one disc. All patients had disc degeneration of Pfirrmann classification grade 1 or higher, with more significant disc degeneration in painful discs than in painless discs. There was no significant relationship between the presence or absence of pain and Modic type. The average VAS measurements improved significantly from 9.5 (pre-procedure) to 2.5 (post-procedure). These results suggest that the most painful discs were the causes of discogenic lumbar pain. CONCLUSIONS Our ultrasound-guided disc pain induction test may help diagnose disc degeneration and identify culprit lesions, even when multiple discs exhibit findings of degeneration.
Collapse
Affiliation(s)
- Keisuke Masuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 6348522, Japan
| | - Hideki Shigematsu
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 6348522, Japan.
| | - Manabu Maeda
- Department of Orthopedic Surgery, Maeda Orthopaedic Clinic, 864-1, Kideracho, Nara City, Nara, 6308306, Japan
| | - Akinori Okuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 6348522, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara, 6348522, Japan
| |
Collapse
|
2
|
Maeda M, Maeda N, Masuda K, Kamatani Y, Takamasa S, Tanaka Y. Ligamentum Flavum Rupture by Epidural Injection Using Ultrasound with SMI Method. Tomography 2023; 9:285-298. [PMID: 36828375 PMCID: PMC9964737 DOI: 10.3390/tomography9010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
The loss of resistance (LOR) method has been used exclusively to identify epidural space. It is difficult to find the epidural space without the risk of dural puncture. Various devices have been developed to improve the accuracy of the LOR method; however, no method has overcome the problems completely. Therefore, we devised a ligamentum flavum rupture method (LFRM) in which the needle tip is placed only on the ligamentum flavum during the epidural injection, and the injection pressure is used to rupture the ligamentum flavum and spread the drug into the epidural space. We confirmed the accuracy of this method using ultrasound with superb microvascular imaging (SMI) to visualize the epidural space. Here, we report two cases of 63-year-old and 90-year-old males. The 63-year-old patient presented with severe pain in his right buttock that extended to the posterior lower leg. The 90-year-old patient presented with intermittent claudication every 10 min. LFRM was performed, and SMI was used to confirm that the parenteral solution had spread into the epidural space. Our results indicate that LFRM can be used for interlaminar lumbar epidural steroid injections.
Collapse
Affiliation(s)
- Manabu Maeda
- Department of Orthopedics, Maeda Orthopaedic Clinic, Nara 630-8306, Japan
- Correspondence: ; Tel.: +81-742-24-5595
| | - Nana Maeda
- Department of Orthopedics, Maeda Orthopaedic Clinic, Nara 630-8306, Japan
| | - Keisuke Masuda
- Department of Orthopedics, Higashiosaka Medical Center, Osaka 578-8588, Japan
| | - Yoshiyuki Kamatani
- Department of Orthopedics, Saiseikai Nara Hospital, Nara 630-8145, Japan
| | - Shimizu Takamasa
- Department of Orthopedics, Nara Medical University, Nara 634-8521, Japan
| | - Yasuhito Tanaka
- Department of Orthopedics, Nara Medical University, Nara 634-8521, Japan
| |
Collapse
|
3
|
Lam KHS, Hung CY, Wu TJ, Chen WH, Ng TKT, Lin JA, Wu YT, Lai WW. Novel Ultrasound-Guided Cervical Intervertebral Disc Injection of Platelet-Rich Plasma for Cervicodiscogenic Pain: A Case Report and Technical Note. Healthcare (Basel) 2022; 10:healthcare10081427. [PMID: 36011084 PMCID: PMC9408075 DOI: 10.3390/healthcare10081427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Ultrasound-guided needle placement into the cervical intervertebral discs using a lateral-to-medial approach is reportedly possible. Clinically, however, patients commonly present with very high uncovertebral joints or narrowed intervertebral spaces, making the method difficult or impossible. This report presents a novel ultrasound-guided needle placement technique to the cervical intervertebral discs using a more medial approach between the trachea/thyroid gland and the carotid sheath. A patient presented with neck pain radiating to the right shoulder and right-sided interscapular regions that affected his sleep and daily functioning. Physiotherapy, selective nerve root block, and percutaneous endoscopic right C7 laminotomy did not sufficiently improve his condition, which progressed to bilateral interscapular and bilateral shoulder pain. Provocative discography was performed with injection of leukocyte-poor and red blood cell-poor platelet-rich plasma to provoke the discogenic pain, which was treated with platelet-rich plasma mixed with lidocaine. The patient recovered well. A month later, there was a significant decrease in the neck disability index score from the initial 28/50 to 14, and there was a further decrease to 5 after 2 months. In conclusion, this medial approach of ultrasound-guided cervical disc needle placement is feasible, even in patients where disc access by previously described approaches is impossible.
Collapse
Affiliation(s)
- King Hei Stanley Lam
- The Department of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong, China;
- The Department of Family Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- The Department of Family Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11031, Taiwan; (T.K.T.N.); (J.-A.L.)
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Correspondence: ; Tel.: +852-2372088
| | - Chen-Yu Hung
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan;
| | - Tsung-Ju Wu
- Graduate Institute of Basic Medical Science, China Medical University, Taichung 40402, Taiwan;
- Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua City 50006, Taiwan
| | - Wei-Hung Chen
- Department of Anesthesiology, E-Da Hospital, Kaohsiung City 82445, Taiwan;
| | - Tony Kwun Tung Ng
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11031, Taiwan; (T.K.T.N.); (J.-A.L.)
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Pain Management Unit, Department of Anaesthesia and Operating Theatre Services, Tuen Mun Hospital, Hong Kong, China
- Department of Anesthesiology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Anesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Frankston Pain Management, Frankston, VIC 3199, Australia
| | - Jui-An Lin
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11031, Taiwan; (T.K.T.N.); (J.-A.L.)
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Anesthesiology, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Anesthesiology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei 11031, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Pain Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 11031, Taiwan
- Department of Anesthesiology, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan;
- Department of Research and Development, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Wai Wah Lai
- The Department of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong, China;
- The Department of Family Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
4
|
Maeda N, Maeda M, Tanaka Y. Direct Visualization of Cervical Interlaminar Epidural Injections Using Sonography. Tomography 2022; 8:1869-1880. [PMID: 35894022 PMCID: PMC9341393 DOI: 10.3390/tomography8040157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022] Open
Abstract
In this case series, we describe a novel ultrasound (US)-guided cervical interlaminar epidural steroid injections (CILESIs) procedure that does not depend on the loss-of-resistance method for epidural space identification. A needle is introduced into three US-identified structures (triple bar sign), the interspinal ligament, ligamentum flavum, and dura mater. The injectants are monitored using superb microvascular imaging during injection. Here, we demonstrate the use of US-guided CILESIs in nine cases and propose the use of sonography, rather than conventional methods, for easier and safer cervical epidural injections. Sonography for direct visualization of cervical epidural injection may allow for outpatient injections.
Collapse
Affiliation(s)
- Nana Maeda
- Maeda Orthopaedic Clinic, 864-1 Kidera-cho, Nara 630-8306, Japan;
| | - Manabu Maeda
- Maeda Orthopaedic Clinic, 864-1 Kidera-cho, Nara 630-8306, Japan;
- Correspondence:
| | - Yasuhito Tanaka
- Department of Orthopedics, Nara Medical University, 840 Shijo-cho Kashihara, Nara 634-8521, Japan;
| |
Collapse
|