Purpose:
Lumbar transforaminal selective nerve root injection (SNRI) is effective for controlling radicular pain. However, when a patient occasionally experiences severe foraminal stenosis, osteophytes cover the outside opening of the neural foramen, preventing clinicians from inserting a needle tip within the neural foramen.
Patients and methods:
An 81-year-old man complained of left L5 radicular pain (left thigh and calf) due to severe left L5-S1 foraminal stenosis. After failure of conventional transforaminal SNRI in the left L5 due to severe degenerative change in the lumbar spine, SNRI was performed using a Racz catheter. After inserting a 16-gauge cannula via the sacral hiatus, the Racz catheter was inserted. The tip of the catheter was positioned near the left L5 nerve root. After confirming the location of the needle tip using a contrast dye, 20 mg (40 mg/mL) of triamcinolone with 0.5 mL of 1% lidocaine and 2 mL of normal saline was injected.
Results:
Immediately after the procedure, the patient's pain completely disappeared. During the 1- and 2-month follow-ups, the patient reported only slight pain in the thigh and calf.
Conclusion:
When it is not possible to perform a conventional transforaminal SNRI, SNRI using a Racz catheter can be an effective treatment option for controlling lumbar radicular pain.