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Procedure-based nonsurgical management of lumbar zygapophyseal joint cyst-induced radicular pain
Steven R Sabers1, Scott R Ross, Brian E Grogg
1Department of Physical Medicine and Rehabilitation, Mayo Medical School, Rochester, MN 55905, USA.
Objective:
To evaluate the success of fluoroscopically guided, contrast-enhanced lumbar zygapophyseal joint (Z-joint) aspiration and steroid injection combined with transforaminal epidural steroid injections (TFESIs) for the treatment of lumbar Z-joint cyst-induced radicular pain.
Design:
Retrospective case series with independent follow-up.
Setting:
Institutional, referral center.
Participants:
Twenty-three patients referred to a single provider for procedure-based management of radicular pain believed secondary to lumbar Z-joint cyst. Inclusion criteria consisted of lumbar radicular pain that was consistent with the level and side of the Z-joint cyst as a causative lesion.
Interventions:
Eighteen patients were treated with a fluoroscopically guided, contrast-enhanced Z-joint aspiration and steroid injection at the level of the causative cyst coupled with a fluoroscopically guided, contrast-enhanced TFESI over the level of the presumably irritated spinal nerve.
Main Outcome Measures:
Patient satisfaction, and whether or not surgery was performed.
Results:
Fifty percent of patients treated with the procedure had significant long-term benefit and avoided surgical intervention at an average follow-up of 9.9 months.
Conclusions:
Fluoroscopically guided, contrast-enhanced spinal procedures as part of an aggressive nonsurgical treatment program are a safe and effective alternative to surgical intervention for lumbar Z-joint cyst-induced radicular pain.
