Intra-articular Steroids vs Saline for Lumbar Z-Joint Pain: A Prospective, Randomized, Double-Blind Placebo-Controlled Trial.

Abstract

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.

• Authors: David J Kennedy, Ryan Fraiser, Patricia Zheng, Lisa Huynh, Joshua Levin, Matthew Smuck, Byron J Schneider
• Journal: Pain medicine (Malden, Mass.) (Pain Med) Vol. 20 Issue 2 Pg. 246-251 (02 01 2019) ISSN: 1526-4637 [Electronic] England
• PMID: 30541041 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: © 2018 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Adrenal Cortex Hormones
• Anti-Inflammatory Agents
• Triamcinolone

Topics

• Adrenal Cortex Hormones (administration & dosage)
• Anti-Inflammatory Agents (administration & dosage)
• Arthralgia (drug therapy)
• Double-Blind Method
• Female
• Humans
• Injections, Intra-Articular
• Low Back Pain (drug therapy)
• Lumbar Vertebrae
• Male
• Middle Aged
• Triamcinolone (administration & dosage)
• Zygapophyseal Joint (drug effects)