Hasoon Jamal, Gill Jatinder, Yazdi Cyrus, Abd-Elsayed Alaa
Department of Anesthesiology, Critical Care, and Pain Medicine The University of Texas Health Science Center at Houston.
Department of Anesthesiology, Critical Care, and Pain Medicine Harvard Medical School, Beth Israel Deaconess Medical Center.
Orthop Rev (Pavia). 2025 Mar 23;17:132329. doi: 10.52965/001c.132329. eCollection 2025.
Caudal epidural steroid injections (ESIs) are a common intervention for lumbar radicular pain, but responses can be variable. When initial injections provide suboptimal relief, targeted approaches using an epidural catheter may enhance efficacy.
We describe three patients with unilateral lumbar radicular pain who underwent caudal ESIs using a 22-gauge spinal needle. Each patient experienced suboptimal pain relief following the initial injection. Patient 1 reported only 30% improvement at the 2-week follow-up. Patient 2 initially experienced 80% pain relief, but this improvement lasted only 3 days, returning to baseline by the 2-week follow-up. Patient 3 reported 40% improvement at the 2-week follow-up. Given their limited response, all three patients underwent a repeat caudal ESI using an epidural catheter advanced toward the symptomatic side and area of interest. After the catheter-guided injection, Patient 1 experienced 70% pain relief, Patient 2 achieved 60% relief, and Patient 3 reported 100% relief, all assessed at the 2-week follow-up.
This case series highlights the potential benefit of catheter-guided caudal ESIs in patients with suboptimal responses to single-shot caudal injections. The improved outcomes suggest that targeted epidural drug delivery may enhance pain relief in select cases of unilateral lumbar radicular pain. Further research is needed to evaluate this approach's long-term efficacy and optimal patient selection.
骶管硬膜外类固醇注射（ESIs）是治疗腰椎神经根性疼痛的常见干预措施，但疗效可能因人而异。当初次注射缓解效果欠佳时，使用硬膜外导管的靶向治疗方法可能会提高疗效。
我们描述了3例单侧腰椎神经根性疼痛患者，他们使用22号脊麻针进行了骶管ESIs。每位患者在初次注射后疼痛缓解效果均欠佳。患者1在2周随访时报告仅改善了30%。患者2最初疼痛缓解了80%，但这种改善仅持续了3天，到2周随访时恢复到基线水平。患者3在2周随访时报告改善了40%。鉴于他们的反应有限，所有3例患者均使用硬膜外导管向症状侧和感兴趣区域推进，再次进行了骶管ESIs。在导管引导注射后，患者1疼痛缓解了70%，患者2缓解了60%，患者3报告疼痛完全缓解，所有这些均在2周随访时评估。
该病例系列突出了导管引导的骶管ESIs对单次骶管注射反应欠佳患者的潜在益处。改善的结果表明，在某些单侧腰椎神经根性疼痛病例中，靶向硬膜外给药可能会增强疼痛缓解效果。需要进一步研究来评估这种方法的长期疗效和最佳患者选择。
