Nonsurgical treatment of zygapophyseal joint cyst-induced radicular pain.

Objective: To evaluate the role of fluoroscopically guided injection procedures in the nonsurgical treatment of zygapophyseal joint cyst-induced radicular pain.

Design: Retrospective study with independent clinical review.

Participants: Fourteen patients (average age, 60.2 yrs), with an average symptom duration of 18.8 months, were included.

Methods: Medical 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 Measures: Pain score, work status, medication usage, and patient satisfaction with treatment.

Results: The 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.

Conclusions: Preliminary 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.