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Ultrasound-guided acupotomy release in the treatment of refractory low back pain: A case report
Zhanying Tang1, Hongkai Zhang, Mingqi Wu
1Department of Rehabilitation Medicine, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Rationale:
Chronic refractory low back pain (LBP) poses a significant clinical challenge, characterized by persistent symptoms lasting ≥ 1 year despite extensive conventional treatments (>90 days of pharmacotherapy and physical therapy). The lack of a standardized management strategy necessitates exploration of alternative interventions. Acupotomy, though effective in releasing soft tissue adhesions, is often performed blindly, carrying potential safety risks and limited precision. This case report aims to illustrate the potential of musculoskeletal ultrasound (MSK-US) guidance to enhance the accuracy, safety, and efficacy of acupotomy for this challenging condition.
Patient Concerns:
A 35-year-old male with a 5-year history of LBP, refractory to prior drug therapy, physiotherapy, and conventional acupuncture, was included.
Diagnoses:
Refractory low back pain.
Interventions:
He initially underwent a blind acupotomy procedure, releasing tender points in the lumbar 5 to sacral 1 paraspinal region with a 0.8 mm needle. Subsequently, he received 2 sessions of MSK-US-guided acupotomy. This targeted approach utilized real-time, high-frequency ultrasound visualization (in-plane technique) to achieve precise release of the multifidus muscle at the lumbar 5 level, specifically targeting identified myofascial trigger points.
Outcomes:
The initial blind acupotomy yielded mild pain reduction (Visual Analog Scale score decreasing from 6-5), though limitations in sitting and standing tolerance persisted. In contrast, the MSK-US-guided acupotomy produced significant relief after the 1st session (Visual Analog Scale decreasing from 5-3), enabling the patient to resume desk work for periods exceeding 30 minutes; near-resolution of symptoms occurred following 2 sessions.
Lessons:
This case demonstrates that MSK-US-guided acupotomy facilitates precise tissue release, enabling rapid and significant symptom control in refractory LBP. The technique's dual mechanism (combining physical adhesion lysis with functional restoration) highlights its potential as a minimally invasive, cost-effective, and superior therapeutic alternative for patients who are not candidates for surgery.
