Intradiscal methylene blue injection for the treatment of chronic discogenic low back pain

Abstract

This article was a preliminary report of prospective clinical trial of a group of patients with chronic discogenic low back pain who met the criteria for lumbar interbody fusion surgery but were treated instead with an intradiscal injection of methylene blue (MB) for the pain relief. Twenty-four patients with chronic discogenic low back pain underwent diagnostic discography with intradiscal injection of MB. The principal criteria to judge the effectiveness included alleviation of pain, assessed by visual analog scale (VAS), and improvement in disability, as assessed with the Oswestry Disability Index (ODI) for functional recovery. The mean follow-up period was 18.2 months (range 12-23 months). Of the 24 patients, 21 (87%) reported a disappearance or marked alleviation of low back pain, and experienced a definite improvement in physical function. A statistically significant and clinically meaningful improvement in the changes in the ODI and the VAS scores were obtained in the patients with chronic discogenic low back pain (P=0.0001) after the treatment. The study suggests that the injection of MB into the painful disc may be a very effective alternative for the surgical treatment of chronic discogenic low back pain.

Figures

Fig. 1

A 36-year-old man with a 3-year history of severe low back pain. a Sagittal T2 weighted magnetic resonance imaging scan showed L5/S1 disc degeneration, with no disc herniation. b Discography showed L5/S1 disc disruption with concordant pain reproduction. Note the contrast media leaking out of posterior annulus through a tear. After discography, 10 mg MB was injected into disc through discographic needle. Three days after injection, low back pain was totally relieved. No recrudescence was observed at a 23-month follow-up interval after treatment