• Thiru M Annaswamy, Corey Armstead, Luke Carlson, Nicholas J Elkins, Denizen Kocak, and Samuel M Bierner.
• From the VA North Texas Health Care System, Physical Medicine & Rehabilitation Service, Department of Physical Medicine & Rehabilitation, UT Southwestern Medical Center at Dallas, Dallas, Texas (TMA); River City Rehabilitation and Spine Specialist, Columbus, Georgia (CA); VA North Texas Health Care System, Interventional Radiology, Dallas, Texas (LC); Department of Physical Medicine & Rehabilitation, UT Southwestern Medical Center at Dallas, Dallas, Texas (NJE); UT Southwestern Medical School, Dallas, Texas (DK); and Department of Physical Medicine & Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska (SMB).
• Am J Phys Med Rehabil. 2018 Apr 1; 97 (4): 278-284.

ObjectiveThe aim of the study was to compare hyaluronate with triamcinolone injections in treating chronic low back pain suggestive of lumbar zygopophyseal joint arthropathy.DesignThis was a prospective, double-blind, randomized controlled trial. Thirty subjects were randomly assigned to receive bilateral L3-S1 lumbar zygopophyseal joint injections with triamcinolone (KA) or Synvisc-One (HA). Pain (visual analog scale) and Pain Disability Questionnaire scores at 1, 3, and 6 mos were evaluated.ResultsNo significant intergroup differences (P > 0.05) in outcomes were noted in the 30 recruited subjects. For KA/HA (baseline; 1 mo; 3 mos; 6 mos), visual analog scale scores were the following: 70 (15)/74 (10); 58 (29)/45 (25); 58 (29)/56 (25); and 59 (28)/63 (24), respectively. Pain Disability Questionnaire scores were the following: 100 (23)/102 (28); 77 (30)/74 (34); 87 (26)/74 (36); and 96 (25)/79 (25). Overall percent improvement at 6 mos for KA was 51 (35) and for HA was 42 (33) (P = 0.51). Synvisc-One group visual analog scale scores improved significantly (70 [20]-45 [25] at 1 mo, P = 0.008). Pain Disability Questionnaire scores improved at 1 mo (100 [23]-77 [30], P = 0.009) in the KA group and at all time points in the HA group (102 [28]-74 [34] at 1 mo, P = 0.002; 74 [36] at 3 mos, P = 0.037; 79 at 6 mos [median = 52-99.5], P < 0.001). Medians and quartiles were used in statistical analysis when data did not pass normality.ConclusionsPatients with chronic low back pain suggestive of lumbar lumbar zygopophyseal joint arthropathy responded similarly to triamcinolone or hyaluronate injections. Synvisc-One group showed significant short- and long-term functional improvement and short-term pain improvement; KA group showed only significant short-term functional benefit and no significant short- or long-term pain improvement.

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