Procedure-based nonsurgical management of lumbar zygapophyseal joint cyst-induced radicular pain

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Abstract

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. © 2005 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

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Sabers, S. R., Ross, S. R., Grogg, B. E., & Lauder, T. D. (2005). Procedure-based nonsurgical management of lumbar zygapophyseal joint cyst-induced radicular pain. Archives of Physical Medicine and Rehabilitation, 86(9), 1767–1771. https://doi.org/10.1016/j.apmr.2004.11.051

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