Combination of gluteal trigger points dry needling and percutaneous endoscopic lumbar discectomy for complex low back-related leg pain

Abstract

Purpose: Causes of low back-related leg pain (LBLP) can be complex and diverse. A detailed medical history, physical examination, laboratory tests, and imaging are necessary to accurately distinguish the pathomechanisms of LBLP and determine the most appropriate treatment. Case: In this study, we report the first documented case in which the combination of dry needling (DN) and percutaneous endoscopic lumbar discectomy (PELD) was used for a patient with active myofascial trigger points (MTrPs) in the gluteus minimus muscle as well as L3-4 lumbar disc herniation (LDH). This 63-year-old woman complained of LBLP for 3 months. After careful examination and analysis, we determined this pain originated from two active MTrPs in the gluteal region and not LDH in L3-4. We first performed MTrPs DN, and the patient’s LBLP was relieved completely. We then performed PELD at the L3-4 level for residual numbness on the medial and anterior aspect of the left lower limb. Finally, the patient received a satisfactory result. Conclusion: The gluteal MTrPs test may be used as a routine examination for patients with LBLP, especially when clinical findings are discordant with imaging results.