title: Procedure-based nonsurgical management of lumbar zygapophyseal joint cyst-induced radicular pain.
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.
  
  
  METHODS
  Retrospective case series with independent follow-up.
  
  
  METHODS
  Institutional, referral center.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Medical School, Rochester, MN 55905, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Sabers
authors.forename: Scott R
authors.initials: SR
authors.lastname: Ross
authors.forename: Brian E
authors.initials: BE
authors.lastname: Grogg
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Lauder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011379:Prognosis; D011843:Radiculopathy / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D013256:Steroids / Q000008:administration & dosage*; D013581:Synovial Cyst / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000503:physiopathology*
chemical_list: D013256:Steroids