Treatment of a symptomatic lumbar perineural cyst with steroid administration and nerve root pulsed radiofrequency

Abstract

We present a case of a lumbar perineural cyst treated with nerve root pulsed radiofrequency and steroid therapy to address severe lower limb pain. The patient, a 43-year-old man, sought care at our orthopedic department for persistent left thigh pain, rated 7 on the numerical rating scale (NRS) for the past month. He exhibited left L3 radicular pain, and lumbar MRI confirmed a 10 mm perineural cyst at the left L3 nerve root. Referred for pain management, the patient received pulsed radiofrequency therapy combined with steroid administration, resulting in pain reduction to NRS 2. Perineural cysts, extensions of the dura mater along the nerve root, are often discovered incidentally through advanced imaging techniques. While most remain asymptomatic, they can cause pain from nerve root compression or bone erosion. Various interventions, including surgical options and percutaneous cyst puncture, have proven effective, underscoring the potential of pulsed radiofrequency therapy for radicular pain related to lumbar perineural cysts.