Intradiskal methylene blue treatment for diskogenic low back pain.
BACKGROUND
Low back pain is a leading cause of pain and disability. The intervertebral disk has been identified as the most common source of chronic low back pain. Although prior treatments directed at intervertebral disks have been disappointing, recent studies show promising improvement of pain and function after a single intradiskal injection of methylene blue.


OBJECTIVE
To assess changes in pain and function in patients with diskogenic low back pain, diagnosed by diskography, after an intradiskal injection of methylene blue.


METHODS
Prospective trial.


METHODS
Patients diagnosed with diskogenic pain by diskography underwent a single treatment of intradiskal injection of methylene blue, determined by prior provocation diskography.


METHODS
Pain and function measurements were completed at baseline and 1, 2, and 6 months after treatment. Treatment was considered a categorical success based on a 30% improvement in pain according to a visual analog scale (VAS) and function on the Oswestry Disability Index (ODI). Treatment was considered a categorical failure if less than 30% improvement in pain and function was achieved or if the patient pursued other invasive treatment options during the trial period.


RESULTS
Sixteen patients received the intradiskal methylene blue injection. Eleven patients received a single-level injection, 4 patients received a 2-level injection, and one patient received injections at 3 levels. For the VAS, at 1, 2, and 6 months after the injection, the categorical success rates were 25%, 21%, and 25%, respectively. For the ODI, at 1, 2 and 6 months after the injection, the categorical success rates were 25%, 21%, and 33%, respectively. The overall categorical success rates at 1, 2, and 6 months after the injection were 19%, 21%, and 25%, respectively.


CONCLUSIONS
This small trial did not demonstrate overall clinical success of intradiskal methylene blue injection for patients diagnosed with diskogenic pain by diskography.
APM Spine and Sports Physicians, Virginia Beach, VA(∗). Electronic address: levid@cox.net.
David S
DS
Levi
APM Spine and Sports Physicians, Virginia Beach, VA(†).
Scott
S
Horn
APM Spine and Sports Physicians, Virginia Beach, VA(‡).
Edward
E
Walko
D000293:Adolescent; D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007278:Injections, Spinal / Q000379:methods; D007403:Intervertebral Disc; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D017116:Low Back Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D008159:Lumbar Vertebrae; D008297:Male; D008751:Methylene Blue / Q000008:administration & dosage* / Q000627:therapeutic use; D008875:Middle Aged; D009192:Myelography; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D004791:Enzyme Inhibitors; D008751:Methylene Blue