Chronic Low Back Pain Injection Spot

Lumbar paraspinous muslces and sacroiliac ligaments all attach to sacrum making it a vulnerable site. Dr. Breck McKay has found injection of these ligments (and the sacrospinous ligament) can give significant results. Poster at IASP congress found a sweet spot at s2 30 mm from midline.

IASP Congress Montreal 2010 Poster Presentation Number: PM 081
PARASACRAL LIGAMENTO-ENTHESEAL INJECTIONS OF METHYLPREDNISOLONE AND LIDOCAINE IN THE TREATMENT OF CHRONIC NONSPECIFIC LOW BACK PAIN (CNLBP) IN PRIMARY CARE
P. Todorov

• 30 cases, 39 – 81 years of age (mean 67 )- moderate to severe Chronic LBP > 3 months’ duration
• Site on sacrum where many tissues attach and richly innervated.
• 5 ml 1% lidocaine, 20 mg depo methylprednisolone, 2.5 mls saline – injected 30 mm lateral to S2 on bone fanned out over tender area

Results at 30 days – VAS dropped from 6.3 to 2.5 on average.

Comment – Picking older patients helped improve results. I talked with Dr. McKay would would inject the entire tender sacrum with large volumes of 1% lidocaine – 20+mls without steroid at least to start with. NOTE – injections are done onto bone; if he goes into sacral foramen, he pulls back and doesn’t worry about it. He would also, with finger in rectum like for piriformis injection, inject ends of sacrospinous ligament. I have a lady with severe chronic back pain that has a spinal stimulator. She still has pain sacrally which is disabling. I injected, under antibiotic cover, the sacral areas. She has had considerable relief of pain and is grateful.