Corticosteroid Injections into Lumbar Facet Joints: A Prospective, Randomized, Double-Blind Placebo-Controlled Trial

Background Corticosteroid injections into the intra-articular (IA) zygapophysial (z-joints) are frequently utilized to treat this cause of low back pain. No studies have been done on the efficacy of IA corticosteroids in those with z-joint pain confirmed by dual comparative medial branch blocks (MBB). Objective To determine if an injection of a corticosteroid into lumbar z-joints is effective in reducing pain and the need for radiofrequency neurotomy (RFN). Design Double-Blind, prospective, randomized, placebo controlled trial Setting Academic Medical Center Patients 28 subjects with z-joint pain confirmed by MBBs. Methods Subjects with confirmed z-joint pain via dual comparative MBB were randomized to receive either intra-articular corticosteroid (triamcinolone 20 mg) or saline via fluoroscopic guided injection. Outcomes Need for RFN Results No statistically significant difference in the need for radiofrequency neurotomy (RFN) between the groups, with 75% [95% CI (50.5-99.5%)] of the saline group vs 91% [95% CI (62.3-100%)] of the corticosteroid group receiving RFN. No difference in mean time to RFN between saline (6.1 weeks) and corticosteroid (6.5 weeks) groups. Conclusions Corticosteroid injections into the lumbar z-joints were not effective in reducing the need for RFN of the medial branches in those with z-joint pain confirmed by dual comparative MBBs. Corresponding Author: Byron J Schneider MD, 2201 Children's Way, Suite 1318, Nashville, TN 37212, CA 94063, Email: Byron.j.schneider@vanderbilt.edu No relevant disclosures for any authors Funding from the Spine Intervention Society Findings previously presented in abstract form at AAPM&R and SIS annual meetings. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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