hi Dr Frank Johnson from Sports Medicine ultrasound there's some patients in which I choose to treat their lumbar spine with cortisone injections with Prolotherapy or with PRP today my patient we've done all three of them in the past we've done Cortisone and Prolotherapy today is the first time we'll be treating with PRP however the linear Clary cell 15 can do a great job of many things however sometimes a curve probes nice to have we don't have that today so I will demonstrate to you how to do lumbar spine using the linear probe in case that's all you have in your clinic first off it's nice to have a patient who weighs less than 150 pounds I strongly advise if you have a patient that weighs more than 150 pounds to look into buying a clarius curb probe what we find here is the spinous process in the center we slide laterally and we know that the set joint injection will be halfway between the transverse process and the spinous process here we see a very good view of both the superior articular process and the inferior articular process Center guide increase gain increase gain here we can see our Facet Joint place a small amount of anesthetic in the skin it'll freeze sorry and we travel down to the Joint there you can very clearly see the needle traveling down to the hyperechoic area of the facet joint I'll now travel down to the next level inferiorly this is going to be the L5 S1 facet joint sorry a little poke now can I see my needle perfectly all the time no I can't but with practice I can tell where the needle is traveling by adding a small amount of injectate and watching what happens with the tissues around it so now having Frozen up the l45 Facet Joint capsule and the L5 S1 Facet Joint capsule now ready to place the PRP we can very clearly see the needle in place I can feel the needle touching the facet joint I inject a small amount of PRP and you can see it fill up on the screen I make some small movements because with regenerative treatments like this our goal is to fill up the ligaments around the facet joint and get some into the facet joint now we've got the needle at the L5 S1 Facet Joint capsule and that's the treatment completed again I wasn't able to see the needle perfectly all the time A lot of times in ultrasound you can't see the needle perfectly the beauty of this is it can tell me where I wasn't I wasn't anywhere near the epidural space I wasn't out laterally near the transverse process where I risked traveling into the abdomen very safe procedure using ultrasound the linear probe did a great job the curve probe would probably do anything better thank you
