Intradiscal Methylene Blue
This is a very new, and despite a few positive studies, unproven treatment for pain coming from the discs in the spine.
If you are suffering from disc pain, however, and thinking of fusion or disc replacement, both major surgeries, the uncertainty surrounding and experimental nature of this treatment may be an acceptable risk, especially when compared to the long term outcome risk of fusion.
How is it done?
1) intravenous antibiotics, and or sedation.
2) Fluoroscopically, video X-ray guided placement of a small needle inside the suspected painful disc.
3) Disc is injected with contrast to confirm that it is a “bad” disc.
4) If confirmed by the patient as “yes indeed that’s my pain!” then…
5) Inject methylene blue with local anesthetic.
6) Remove needle and over course of the following week pain hopefully diminishes.
How does it theoretically work?
1) Methylene blue, in addition to being a powerful anti-oxidant, is mildly neurotoxic at 0.5 to 1% concentration.
2) With a painful disc, the nerves pathologically grow deep into the disc and feel the disc injuries there, and report the pain up to you, the owner.
3) Injection of the methylene blue stuns/kills the terminal (end of the nerve) nerve fibers inside the disc, rendering the disc painless.
4) It is gradually metabolized inertly.
5) To date, we have had some patients with good success, some with no improvement. No one has gotten worse.
Tell me the bad stuff, the risks, what could happen?
First, its unproven. It is an EXPERIMENTAL procedure. However…
There IS internationally peer-reviewed, well performed, double blinded, placebo controlled, prospective evidence of efficacy– in China.
A few papers have been published. It appears to be safe. It has been injected in the body for decades without consequence.
There has been a 0% complication rate. We have had no complications.
However, as methylene blue is a bright blue color it was injected into the spinal CANAL early on to track cerebral spinal fluid flow, and putting the neurotoxin inside the sac containing the spinal nerves was a bad idea. It killed the nerves there and there werecatastrophic outcomes. That should give you pause.
It underscores that ALL MEDICAL PRACTICE, and ALL LIFE has RISK.
That’s why we use video x-ray guidance, to virtually guarantee intradiscal injection.
Putting the needle in the thecal sac, while intending to put it in the disc, is possible, but with xray confirmation, it would be VERY DIFFICULT to do without intending to do.
So. Its possible, but highly unlikely, and the photos prove the location.
You can’t take a picture of you in Boston when you’re in San Diego.
Methylene blue has not been studied in long term outcomes.
You can develop infection with any injection, but infection in the disc is serious.
The exiting nerve may be pierced or injured.
Discuss this with me, know the full compliment of risks.
The first and bedrock tenet of medicine: “First do no harm…” is key to our philosophy and practice!