PONOS CLINICAL CASES · SPINE
Regaining mobility despite persistent spinal stenosis
Lumbar stenosis and left L5 radicular pain treated with epidural adhesiolysis and pulsed radiofrequency, with follow-up to one year.
Procedure date: 17 March 2023. Date established from the original photograph metadata.
The initial presentation
An 86-year-old patient presented with lumbar spinal stenosis, claudication and a reported walking distance of approximately 30–50 metres. Chronic left L5 radiculopathy was accompanied by partial weakness in the affected myotome and tingling paraesthesia, particularly at night when lying down.
Clinical reasoning
Lumbar decompression with fusion had been considered unsuitable in this individual because of the overall risk associated with comorbidities and age. Age alone is not presented as a contraindication to surgery.
The aim was to reduce radicular pain and improve mobility. The intervention was not intended to correct the anatomical narrowing of the spinal canal.
The combined procedure
Under fluoroscopic guidance, a left L5–S1 foraminal approach using a blunt-tip radiofrequency needle was combined with a sacral approach using an epidural adhesiolysis catheter. Contrast was administered through both routes to complete the epidurogram.
Follow-up findings
| Time point | Reported outcome |
|---|---|
| Before treatment | Walking distance approximately 30–50 metres. |
| 3 months | Walking distance approximately 1,000 metres. |
| 6 months | Complete remission of radicular pain. |
| 12 months | Maintained pain remission; walking distance approximately 500 metres, with a sustained substantial improvement in quality of life. |
What improved and what persisted
Remission refers to radicular pain, not resolution of every feature of radiculopathy. Spinal stenosis persisted, and reduced superficial touch sensation was identified in the same territory. The available information does not establish treatment-related onset of this sensory deficit or document recovery of muscle strength.
At one year, walking distance remained markedly greater than at baseline, although lower than at three months. The quality-of-life benefit was reported clinically; no standardised score was included in the information supplied.
What this case illustrates
This case illustrates sustained clinical and functional improvement in a patient with limited surgical options. Because two procedures were combined, their individual contributions cannot be separated. A single case does not establish general effectiveness or predict outcomes for other patients.
Further reading
- Lumbar epidural adhesiolysis: indications, pathway and limitations
- Guy’s and St Thomas’ NHS: Epidurolysis to treat pain — patient information about the procedure, not evidence for this individual case or the specific combined intervention.
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