A Narrative Review of Intra-articular Zygapophysial Steroid Injections for Lumbar Zygapophysial-Mediated Pain

The majority of Americans will experience low back pain during their lifetime. Pain arising from the lumbar zygapophyseal joints (z-joints) is one cause of low back pain. Specifically, degenerative changes occur in these joints similarly as in other diarthrodial joints. Intra-articular corticosteroid injections are a common and accepted treatment for osteoarthritis in other body regions such as the knees and hips. Unsurprisingly, corticosteroid injections into the lumbar z-joints have long been viewed as a potential therapeutic option for lumbar z-joint pain. This narrative review will discuss the current available evidence for lumbar z-joint corticosteroid injections. Many of the studies covered are limited by poor patient selection or lack of control group. Based on the current available evidence, it is likely that there is a small subset of patients with low back pain that may respond to lumbar z-joint steroid injections, though experimentally, these have only been identified as those with abnormal z-joint uptake on SPECT imaging. Further studies, ideally randomized placebo controlled studies that only enroll patients with confirmed z-joint mediated low back pain, are greatly needed. © 2016, Springer Science + Business Media New York.