Intra-articular Steroids vs Saline for Lumbar Z-Joint Pain: A Prospective, Randomized, Double-Blind Placebo-Controlled Trial. Pain medicine (Malden, Mass.) Kennedy, D. J., Fraiser, R., Zheng, P., Huynh, L., Levin, J., Smuck, M., Schneider, B. J. 2018


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 20mg), 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 6.00weeks for steroids vs 6.55weeks 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.

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