Intra-articular Steroids vs Saline for Lumbar Z-Joint Pain: A Prospective, Randomized, Double-Blind Placebo-Controlled Trial.
OBJECTIVE
To determine if intra-articular (IA) injection of corticosteroids is effective in reducing the need for radiofrequency ablation (RFA) in those with dual comparative medial branch block (MBB)-confirmed lumbar z-joint pain.


DESIGN
This was a randomized, double blind, placebo-controlled study.


SETTING
Two academic medical centers.


SUBJECTS
Fifty-six consecutive subjects who had ≥80% pain relief during an initial screening MBB were recruited.


METHODS
Patients received a second confirmatory MBB and concurrent IA injection of either corticosteroid or saline per randomization. Twenty-nine of 56 received intra-articular corticosteroid (triamcinolone 20 mg), of whom 24 also had a positive confirmatory MBB per Spine Interventional Society guidelines, with ≥80% pain relief from both MBBs. Twenty-seven of 56 received IA saline into the z-joint during the confirmatory MBB, of whom 22 also had a positive confirmatory MBB. The primary outcome measure was the categorical need for RFA due to insufficient pain relief with intra-articular injection, and the secondary outcome was time to RFA.


RESULTS
There was no statistically significant difference in the need for an RFA between the groups (16/24 steroid, 67%, 95% confidence interval [CI] = 47-82%) vs 15/22 saline (68%, 95% CI = 47-84%, P = 1.00). The average time to RFA was also not different, at 6.00 weeks for steroids vs 6.55 weeks for saline (P = 0.82).


CONCLUSIONS
Intra-articular corticosteroids were not effective in reducing the need for or the time to a radiofrequency ablation of the medial branches in those with dual MBB-confirmed lumbar z-joint pain.
['Kennedy|David J|DJ|', 'Fraiser|Ryan|R|', 'Zheng|Patricia|P|', 'Huynh|Lisa|L|', 'Levin|Joshua|J|', 'Smuck|Matthew|M|', 'Schneider|Byron J|BJ|']
D000305:Adrenal Cortex Hormones D000893:Anti-Inflammatory Agents D018771:Arthralgia D004311:Double-Blind Method D005260:Female D006801:Humans D007270:Injections, Intra-Articular D017116:Low Back Pain D008159:Lumbar Vertebrae D008297:Male D008875:Middle Aged D014221:Triamcinolone D021801:Zygapophyseal Joint
Steroids Medial Branch Facet Joint Low Back Pain Zygoapophyseal Joint