Enhanced Pain Relief with Catheter-Guided Caudal Epidural Steroid Injections: A Case Series of Patients with Unilateral Lumbar Radicular Pain.

Background: 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. Case Series: 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. Conclusion: 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.