A case of ultrasound-guided L4 nerve root pulsed radiofrequency with subfascia iliaca anterior approach in the supine position

Abstract

We report a case of postoperative residual pain for L4 schwannoma treated with pulsed radiofrequency (PRF) to the L4 nerve root using Shamrock view (SV) and anterior approach through fascia iliaca compartment (FI) in the supine position. The patient, a 50-year-old man, was diagnosed with right L4 schwannoma and had undergone tumor resection with motor branch preservation at another hospital. Following the surgery, he developed pain and numbness in his right lower extremity. He came to our hospital because of his residual pain. We performed an ultrasound-guided pulsed radiofrequency (PRF) treatment at 42℃ for 8 minutes on the right L4 nerve root via SV and FI in the supine position, as we could confirm the schwannoma and the nerve root within the psoas muscle. The patient experienced pain relief from the PRF treatment. Our case suggests that lower lumbar root PRF with an extraperitoneal approach in the supine position can be effective when conventional methods are challenging.