Ultrasound is a radiation-free, easy-to-use imaging tool in diagnosing soft tissue lesions and in performing precise ultrasound guided injections. The injection needle can be accurately guided to the designated area for aspiration and injection procedures. Our studies have indicated that ultrasound can be applied in performing accurate medial branch, and caudal epidural, piriformis muscle, lumbosacral facet joints, quadratus lumborum muscle, and sacroiliac joint injections. Under ultrasound guidance, the advancing motion of the needle can be observed as continuous and real-time images.
　　Prolotherapy is frequently applied nowadays in the treatment of ligament and tendon pathologies. An irritant solution is injected to the affected site with the intention of promoting tissue regeneration. Different osmolarity of the solution can be titrated to achieve different goals. For example, a dextrose solution with 20% can achieve regeneration and 10% can result in pain relief and anti-inflammatory purposes. Of course, prolotherapy can be administered more accurately now to the aforementioned sites using ultrasound guidance.
　　In the past, fluoroscopic needle guidance was needed to perform injection procedures such as caudal epidural injection. In nowadays, these spinal injections can be performed accurately and safely in an outpatient clinical setting. The application of precision medicine in using ultrasound-guided injection techniques to treat low back pain will be thoroughly covered in this talk.