Comparative Outcomes of Intra-articular Corticosteroid Injections and Medial Branch Blocks for Lumbar Facet Joint Syndrome: A Retrospective Study

Background Lumbar facet joint syndrome (LFJS) is a recognized source of chronic low back pain. Interventional approaches, such as intra-articular corticosteroid (IAC) injections and medial branch blocks (MBBs), are employed for pain management, although clinical use varies geographically. While MBBs are commonly used in the United States, primarily as diagnostic tools before radiofrequency ablation, intra-articular injections remain in use in other settings. This study compares the efficacy and safety of these two approaches in managing LFJS. Methods This retrospective cohort study included 62 patients with clinically suspected LFJS based on clinical criteria and supported by imaging findings. Group A (n = 30) received IAC injections (triamcinolone acetonide 40 mg with 1-2 mL of 1% lidocaine per level), and Group B (n = 32) received MBBs (0.5 mL of 0.5% bupivacaine per targeted medial branch). Injections were performed bilaterally at one or two levels under fluoroscopic guidance. Pain intensity was assessed using the Visual Analog Scale (VAS), and functional status was evaluated using the Oswestry Disability Index (ODI). Results Both interventions resulted in significant pain reduction and functional improvement over time (p < 0.001 for intra-group comparisons). At six months, VAS scores improved from 7.6 ± 1.2 to 4.1 ± 1.2 in Group A, and from 7.4 ± 1.1 to 3.9 ± 1.1 in Group B. While both interventions are traditionally associated with short-term relief, we observed continued benefit in a subset of patients, potentially due to factors such as placebo effect, natural course of the disease, or conservative adjunct treatments. ODI scores improved from 48.5 ± 5.6 to 32.1 ± 4.2 in Group A, and from 49.1 ± 5.4 to 31.7 ± 4.0 in Group B (p = 0.812). No significant differences in pain reduction or functional outcomes were observed between the two groups at any time point (p > 0.05). Adverse events were minimal and comparable between groups (p > 0.05). Conclusion In this cohort, both IAC injections and MBBs were associated with subjective improvements in pain and function over a six-month period. However, these findings should be interpreted with caution, as they diverge from existing literature that typically reports only short-term benefits from these interventions. Our results may reflect placebo effects, natural symptom fluctuation, or adjunctive non-interventional treatments. Further prospective studies with control groups and longer follow-up are needed to clarify the durability of these effects.