{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:01:46Z","timestamp":1785391306584,"version":"3.55.0"},"reference-count":11,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pain Res."],"abstract":"<jats:p>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\u2013L4 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\u2013L4 arthrodesis, multilevel degenerative disc disease, and an L4\u2013L5 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.<\/jats:p>","DOI":"10.3389\/fpain.2026.1907035","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:40:11Z","timestamp":1785390011000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Single-access epidural adhesiolysis and catheter-delivered pulsed radiofrequency for refractory failed back surgery syndrome"],"prefix":"10.3389","volume":"7","author":[{"given":"Rafael","family":"Nascimento","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Federal University of Mato Grosso do Sul (UFMS)","place":["Campo Grande, MS, Brazil"]},{"name":"Pain Medicine Fellowship, Federal University of Mato Grosso do Sul (UFMS)","place":["Campo Grande, MS, Brazil"]},{"name":"Pain Service, Maria Aparecida Pedrossian University Hospital (HUMAP-UFMS)","place":["Campo Grande, MS, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"361","DOI":"10.36076\/ppj.2009\/12\/361","article-title":"Systematic review of percutaneous adhesiolysis and management of chronic low back pain in post lumbar surgery syndrome","volume":"12","author":"Epter","year":"2009","journal-title":"Pain Physician"},{"key":"B2","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1111\/j.1533-2500.2008.00203.x","article-title":"Percutaneous lysis of epidural adhesions\u2014evidence for safety and efficacy","volume":"8","author":"Racz","year":"2008","journal-title":"Pain Pract"},{"key":"B3","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1590\/S0102-86502012000400013","article-title":"The application of percutaneous 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dorsal root ganglion pulsed radiofrequency in patients with chronic lumbosacral radicular pain","volume":"13","author":"Jandura","year":"2023","journal-title":"J Pers Med"},{"key":"B10","article-title":"A novel technique to deliver epidural pulsed radiofrequency for the management of persistent lumbar radicular pain in failed back surgery syndrome\u2014a case report","author":"Lifford","year":""},{"key":"B11","doi-asserted-by":"publisher","first-page":"100145","DOI":"10.1016\/j.inpm.2022.100145","article-title":"Ultrasound-guided caudal epidural pulsed radiofrequency for the treatment of failed back surgery syndrome: results of a prospective clinical study","volume":"1","author":"G\u00fcven K\u00f6se","year":"2022","journal-title":"Interv Pain Med"}],"container-title":["Frontiers in Pain 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