Anatomical Study Of Ultrasound-guided Lumbar Soft Tissue Acupuncture

[Background]In recent years,the use of acupotomy has substantially better clinical effects in treating of lumbar disc herniation,lumbar transverse process syndrome,lumbar spinal stenosis,and other related diseases by releasing lumbar soft tissue and restoring mechanical balance.However,traditional acupotomy lysis is still rather risky and difficult without visual field.Due to the restriction of the closed surgical field of vision,the needle is often placed on the base of the surface of the body surface,and the needle and the auxiliary hand are coordinated to find the site of the treatment,so there is still a treatment accident outside the line of sight.It is evident that there is a lack of sufficient data for visualization in the field of acupotomy.Therefore,we had undertaken ultrasound guidance to map out the insertion route of the acupotomy needles to further provide anatomical evidence.[Objectives]In order to provide anatomical basis for the clinical treatment of lumbar disc herniation,we used ultrasound-guided acupotomy lysis on lumbar facet joint(LFJ)and lumbar intervertebral foramina(LIF).Real-time ultrasound guidance on fresh cadavers,combined with body surface marker positioning,ultrasonic probe placement,approach of acupotomy,top of acupotomy release real-time image location and other factors,in order to design a repeatable and safe operation.[Methods]12 cadavers(the average age of the 8 males and 4 males is 73.42)without any embalming of formalin were selected to perform the ultrasound-guided acupotomy lysis.We conducted thorough analyses to determine the correlation between angles and depths of needle insertions on LFJ and edge of transverse process of LIF performed on the 12 cadavers.Statistical analyses were carried out using SPSS 20.0.Three segments of bilateral L3/L4,L4/L5 and L5/S1 were measured on the lumbar joint,and two segments of bilateral L3/L4 and L4/L5 were measured at the transverse edge of the intervertebral foramen,and the distance between the anterior branch of the L4 nerve to the root upper margin of the L5 transverse process.[Results]There was a statistical difference and correlation between the ultrasound-guided(UG)data and cadaver data:thedepth of needle insertion on UG(U-A),the distance between the puncture point and spinous process on UG(U-B),thedepth of needle insertion on cadaver(A)and the distance between the puncture point and spinous process on cadaver(B).Ratios of the above measurements on edge of transverse process of LIF and on LFJ resulting from linear equation both are 1.08.There was no significant difference in the results of bilateral paired T test for the LFJ and LIF(P>0.05).Under anatomical observation,the L4 nerve anterior branch from L5 transverse root border averaged 11.78±2.55mm,and there was no significant difference in the results of bilateral paired T test for both sides(P>0.05).[Conclusion]Acupotomy lysis could be accurately located on LFJ and edge of transverse process of LIF by utilizing ultrasound guidance.Ultrasound guidance provided real-time monitoring during the acupotomy lysis,thus the progress of acupotomy lysis could be visualized.Under the anatomical observation,there were no obvious vessels and nerves around the path of the LFJ and LIF.The anatomic basis was provided for the sonography of the LFJ and LIF under the guidance of ultrasound-guided acupotomy lysis.The average distance between the anterior branch of bilateral L4 nerve to the root upper margin of L5 transverse process,the right side is larger than the left side.