• C W Slipman, J S Lipetz, Y Wakeshima, and H B Jackson.
• Department of Rehabilitation Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
• Arch Phys Med Rehabil. 2000 Jul 1; 81 (7): 973-7.

ObjectiveTo evaluate the role of fluoroscopically guided injection procedures in the nonsurgical treatment of zygapophyseal joint cyst-induced radicular pain.DesignRetrospective study with independent clinical review.ParticipantsFourteen patients (average age, 60.2 yrs), with an average symptom duration of 18.8 months, were included.MethodsMedical records were reviewed; patients with a radiographically observed zygapophyseal joint cyst that may have represented a compressive lesion corresponding to the patient's symptoms of radicular pain were eligible for inclusion. The level of nerve root involvement was confirmed by physical examination or electrodiagnostic findings. Patients whose root level involvement remained undetermined were required to demonstrate a positive response to a fluoroscopically guided diagnostic selective nerve root block (SNRB). Nonsurgical treatments included therapeutic SNRB, intraarticular zygapophyseal joint corticosteroid injection, and cyst puncture. Data collection and analysis were performed by an independent clinical reviewer.Outcome MeasuresPain score, work status, medication usage, and patient satisfaction with treatment.ResultsThe majority of the observed cysts (71.4%) were at the L4-L5 level. Follow-up data collection was done at an average of 1.4 years after termination of treatment. An excellent outcome was observed in 4 patients (28.6%). Fifty percent of patients underwent surgery.ConclusionsPreliminary findings suggest a role for fluoroscopically guided injection techniques in the nonsurgical treatment of zygapophyseal joint cyst-induced radicular pain, with up to one-third of patients experiencing lasting symptomatic relief.

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