A Case Where the Epidural Block Was Useful for the Differential Diagnosis of Low Back Pain in a Patient with Esophageal Cancer and Lumbar Disc Herniation

Abstract

Introduction: We experienced a case in which an epidural block was useful in estimating the cause of low back pain in a patient suffering from esophageal cancer with liver and paraaortic lymph node metastases. Case: A 69-year-old male with a history of surgery for lumbar disc herniation (at the age of 20). He was diagnosed with esophageal cancer and during follow-up, he noticed low back pain, followed by epigastric pain. MRI revealed L1/2 and L2/3 intervertebral disc herniation. The thoracic epidural block was performed from Th8/9 under X-ray fluoroscopy to alleviate symptoms and identify the cause of low back pain. After confirming the analgesic effect, we conducted a splanchnic nerve block using neurolytic agent (anhydrous ethanol), resulting in total pain elimination. Subsequently, the patient passed away under good pain control without increasing the dose of analgesics. Conclusion: By confirming the effectiveness of epidural block at the thoracic level in advance, the complicated pain was thought to be derived from not lumber disc herniation, but the visceral nerves. An epidural block was useful for the selection of subsequent analgesic therapy.