Case Report: Single-access epidural adhesiolysis and catheter-delivered pulsed radiofrequency for refractory failed back surgery syndrome.

Failed back surgery syndrome (FBSS) frequently involves mixed mechanical, inflammatory, and neuropathic mechanisms and remains challenging to treat, particularly when systemic anti-inflammatory therapy is limited. We report a 55-year-old woman with chronic refractory left lumbosciatica after endoscopic lumbar discectomy and L3-L4 arthrodesis, with established coronary artery disease and prior myocardial infarction limiting the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Lumbar magnetic resonance imaging demonstrated prior L3-L4 arthrodesis, multilevel degenerative disc disease, and an L4-L5 diffuse disc protrusion causing dural-sac compression, degenerative central canal narrowing, and bilateral foraminal narrowing; lower-limb electroneuromyography did not show active large-fiber radiculopathy. A single-session, single-access caudal procedure was performed using a radiopaque steerable epidural catheter-electrode system, allowing both catheter-directed adhesiolysis and sequential epidural pulsed radiofrequency (PRF) delivery through the catheter tip adjacent to the left S1, L5, L4, and L3 dorsal root ganglion/nerve-root regions. At 5 days, the patient reported approximately 60% improvement in the radiating lower-limb pain. At 8 weeks, she reported approximately 70% improvement in the radicular pain component, while overall pain intensity decreased from NRS 9/10 to 5/10, with residual axial low back pain. A transient sacral neuritis with gluteal paresthesia was the only adverse event and resolved with conservative treatment. This case illustrates a combined interventional strategy for selected patients with refractory FBSS, while the single-case, multicomponent design precludes attribution of benefit to any individual element.