TITLE:
Case Series of Methylene Blue Injections for the Treatment of Zygapophysial and Sacroiliac Joint Pain: Results of 5 Cases
AUTHORS:
Jay Parekh, Maxim Eckmann, Somayaji Ramamurthy
KEYWORDS:
Radio Frequency Ablation; Facet; Zygapophysial; Sacroiliac; Methylene Blue; Pain; Interventional
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.3 No.6,
July
26,
2013
ABSTRACT: Introduction: Shealy is credited with the use of fluoroscopy guided radiofrequency ablation
(RFA) for denervation of the lumbar zygapophysial (L-Z) joint in the mid-1970’s. Peng and colleagues described
the use of methylene blue (MB) injection for discogenic pain; MB may work
through direct neurotoxicity or inhibition of nitric oxide synthesis. We
present a retrospective case series of five patients with L-Z or SI joint pain
where MB used as an alternative to RFA. Materials
and Methods: This is a retrospective case series of five patients who
received MB for the chemical neurolysis of either medial or/and lateral
branch’s for zygapophysial or SI joint pain. All of the MB blocks were done
under fluoroscopic guidance and performed in the same manner as diagnostic
medial and lateral branch blocks but with care to consider the medication as
neurotoxic in relation to spinal nerves. On average 1cc of 0.05% final
concentration MB was injected per nerve or sacral foraminal level. Results: Four of the five patients had
significant lasting pain relief. Discussion: Chemical neurolysis has potential to achieve technical success in these
refractory cases of spine pain possibly due to spread over a broader area; for
this same reason the procedure should be performed carefully under fluoroscopic
guidance.