Ultrasound-guided acupotomy release in the treatment of refractory low back pain: A case report.

Researchers reported on a new approach for treating stubborn low back pain that hasn't responded to standard treatments. This case study examined a 35-year-old man who suffered from low back pain for five years that didn't improve with medications, physical therapy, or regular acupuncture. The treatment involved acupotomy, a technique that uses a small needle-like instrument to release tight tissue and adhesions in muscles. Initially, the patient received traditional "blind" acupotomy (without imaging guidance), which provided only minor pain relief—his pain score dropped from 6 to 5 on a 10-point scale, and he still couldn't sit or stand comfortably. The breakthrough came when doctors used musculoskeletal ultrasound to guide the acupotomy procedure. This imaging technology allowed them to see exactly where to release tight spots in the multifidus muscle (a deep back muscle) at the fifth lumbar level. After just one ultrasound-guided session, the patient's pain decreased significantly from 5 to 3, and he could sit at a desk for more than 30 minutes—something he couldn't do before. After two sessions, his symptoms were nearly resolved. This case suggests that using ultrasound guidance makes acupotomy more precise and effective for chronic low back pain that hasn't responded to other treatments. The technique combines physical release of tissue adhesions with restoration of normal muscle function, offering a minimally invasive option for patients who want to avoid surgery. If you're considering this treatment, seek a qualified practitioner trained in both acupotomy techniques and musculoskeletal ultrasound guidance.

This case report describes ultrasound-guided acupotomy for refractory low back pain in a 35-year-old male with a 5-year history unresponsive to pharmacotherapy, physiotherapy, and conventional acupuncture (>90 days). Initial blind acupotomy at L5-S1 paraspinal tender points using a 0.8mm needle yielded modest improvement (VAS 6→5) with persistent functional limitations. Subsequently, two sessions of MSK-US-guided acupotomy were performed using real-time, high-frequency ultrasound with in-plane technique to precisely target myofascial trigger points in the multifidus muscle at L5. Results showed significant improvement after the first guided session (VAS 5→3) with restored sitting tolerance >30 minutes, and near-complete symptom resolution after two sessions. The imaging guidance enabled precise tissue release combining adhesiolysis with functional restoration. Limitations include single-case design without controlled comparison or long-term follow-up. Clinical takeaway: MSK-US guidance may enhance acupotomy precision, safety, and efficacy for refractory LBP, warranting larger controlled studies.