Search Results (103)

Objective: This study aimed to evaluate the clinical and radiological efficacy of percutaneous laser disc decompression (PLDD) in patients with disc-related lumbar spinal stenosis. Methods: Data from 96 patients who underwent PLDD between January 2023 and January 2025 were reviewed retrospectively. Pain intensity (visual analogue scale [VAS]), functional capacity (pain-free walking distance), patient satisfaction (global patient evaluation), and radiological canal diameter were assessed before the procedure and at 1, 3, and 6 months postoperatively. Treatment response was determined based on a ≥2-point decrease in the VAS score, which is the minimal clinically important difference (MCID) criterion. Results: A marked improvement in VAS scores was observed from the early period following PLDD, with the mean VAS score decreasing from 8.02 to 5.02 ± 1.99 at 6 months (p < 0.001). The pain-free walking distance increased from 212.7 m to 345.8 m, resulting in a significant improvement in functional capacity (p < 0.001). A significant increase in the anteroposterior diameter of the spinal canal from 7.1 ± 1.7 mm to 7.9 ± 1.8 mm (p < 0.001) was observed, corresponding to a mean increase of 0.8 mm; however, the magnitude of this radiological change was modest and should be interpreted cautiously. A moderate correlation was found between radiological expansion and VAS change (r = 0.52). At 6 months, 72.9% of patients met the MCID criterion. Although ODI improved significantly over follow-up, the mean reduction remained below commonly accepted MCID thresholds, suggesting that the functional benefit may be modest. No major complications were observed; only short-term transient radicular irritation (2.1%) was seen. Conclusions: PLDD was associated with improvements in pain control, functional capacity, and modest radiological canal enlargement in this cohort of carefully selected patients with single-level, predominantly disc-driven lumbar spinal stenosis. However, because of the retrospective design and absence of a control group, no conclusions regarding comparative effectiveness can be drawn. PLDD should therefore be viewed as a selectively applicable minimally invasive option rather than a general treatment for all forms of lumbar spinal stenosis. The observed clinical benefit was limited to the 6-month follow-up available in this cohort, and its durability beyond this period remains uncertain. Prospective and comparative studies are required to better define its long-term role and its position relative to conservative treatment and surgery. Full article

Background and Objectives: Paramedian cervical interlaminar epidural steroid injection (CESI) is commonly used for cervical radicular pain and is considered safer than the transforaminal approach. However, its clinical effectiveness may be influenced by contrast distribution patterns, although these may not fully reflect actual drug delivery. This study aimed to evaluate the association between needle trajectory, foraminal or periradicular contrast distribution patterns, and short-term pain reduction following paramedian cervical interlaminar CESI. Materials and Methods: This single-center retrospective study included 109 patients who underwent paramedian cervical interlaminar CESI. Needle trajectory was classified as inward or outward. Contrast distribution was graded based on anteroposterior (AP) spread patterns. Pain intensity was assessed using a numeric rating scale (NRS) at baseline and 2 weeks after the procedure. Group comparisons were performed using Welch’s t-test and chi-square or Fisher’s exact test, as appropriate. Effect sizes were calculated using Cohen’s d and η². Multivariable linear regression analysis was performed adjusting for age, sex, baseline NRS, and target level. Results: The outward trajectory group demonstrated a significantly higher proportion of Grade 2 contrast spread compared to the inward group (69.8% vs. 8.9%, p < 0.001). Higher AP contrast spread grades were associated with greater pain reduction (β = 0.83, 95% CI: 0.44–1.22, p < 0.001; η² = 0.14). In addition, patients in the outward trajectory group showed greater NRS reduction than those in the inward group (2.96 vs. 1.71, mean difference: 1.25, 95% CI: 0.74–1.76, p < 0.001; Cohen’s d = 0.96). In multivariable analysis, needle trajectory remained significantly associated with pain reduction, whereas AP contrast spread grade was not independently associated. Conclusions: Needle trajectory was associated with contrast distribution patterns and short-term pain reduction following paramedian cervical interlaminar CESI. An outward-directed trajectory was associated with greater foraminal or periradicular contrast spread and greater pain reduction. These findings suggest that needle trajectory may represent a clinically relevant procedural factor influencing clinical outcomes. Full article

Background/Objectives: Lumbar spinal canal stenosis (LSS) is a major cause of neurological disability and is frequently accompanied by neuropathic pain (NeP). Duloxetine is widely used for NeP, but its clinical role in LSS and the determinants of treatment response remain unclear. This study aimed to identify predictors of duloxetine efficacy in LSS. Methods: We retrospectively analyzed 145 patients with LSS who received duloxetine for ≥3 months (median dose 40 mg) with at least 1-year follow-up. Patients were classified into those with radicular pain or cauda equina syndrome. Treatment response was assessed at 3 months. Stenosis severity was evaluated using the Schizas classification. Multivariable logistic regression analysis was performed to identify independent predictors of duloxetine response in patients with cauda equina syndrome. Results: Duloxetine was effective in 29.4% vs. 52.3% in radicular pain and cauda equina syndrome, respectively. Among patients with cauda equina syndrome, Schizas Grade D was more frequent in responders than non-responders and independently predicted duloxetine response. Nearly 90% of responders had been unresponsive to other NeP medications. A subset of patients with severe stenosis avoided surgery following duloxetine treatment. Conclusions: Duloxetine showed greater efficacy in cauda equina-dominant LSS compared with radicular pain. Paradoxically, more severe spinal canal stenosis tended to be associated with a higher likelihood of response. These findings suggest that neurological phenotype and radiological severity may influence duloxetine responsiveness and support a symptom- and imaging-guided pharmacological management for LSS, although these findings should be interpreted with caution and considered hypothesis-generating given the retrospective study design. Full article

Background/Objectives: Sciatica secondary to lumbar disc herniation is a common cause of chronic radicular pain and functional disability. Since the sciatic nerve is involved in the motor and sensory innervation of the foot, it is important to evaluate the potential distal biomechanical alterations it produces. Evidence regarding the effect of radicular pain on kinetic parameters remains limited and heterogeneous. The aim of this study was to describe gait characteristics in people with chronic unilateral radicular pain due to non-traumatic lumbar or lumbosacral disc herniation and to compare kinetic differences between the affected and unaffected limbs. Methods: A cross-sectional analytical observational study was conducted in 41 patients who met the inclusion criteria. Dynamic baropodometric assessment was performed using the Footscan^® system. The analysis focused on kinetic parameters, including surface area, pressure, and maximum force, as well as spatiotemporal variables comprising stance time, step time, step length, and plantar push-off mechanics. Demographic data, Foot Posture Index (FPI) scores, and muscle strength were also recorded. Results: According to patient reports, the left foot was the most severely affected. Significant differences in muscle strength were found between the affected and unaffected limbs. However, no significant differences were observed in any of the kinetic or spatiotemporal parameters evaluated. Conclusions: Patients with unilateral sciatica due to lumbar disc herniation showed reduced muscle strength in the affected limb with no significant differences in kinetic or spatiotemporal gait parameters, suggesting compensatory mechanisms. Full article

Background/Objectives: Few previous studies have evaluated both radiological changes and the clinical effectiveness of platelet-rich plasma (PRP) injections, a biomedical therapy, in patients with chronic discogenic and/or radicular low back pain. Methods: This retrospective comparative cohort study reviewed patients with chronic LBP (>3 months) refractory to first-line conservative therapy between July 2022 and August 2024. Patients who underwent lumbar transforaminal epidural or intradiscal PRP injections, according to clinical presentation and imaging findings, were assigned to the PRP group. (n = 312), while those continuing conservative treatment served as controls (n = 391). Patients receiving both treatments were excluded. Pain and functional outcomes were evaluated using the Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI). Follow-up continued through February 2025. Results: Baseline demographic and clinical characteristics were comparable between groups (p > 0.05). At three months, the PRP group demonstrated significantly greater reductions in pain (NRS: 4.51 ± 0.79 from a baseline of 7.20 ± 0.89) and disability (ODI: 23.73 ± 3.96 from 37.21 ± 3.14), when compared with the conservative group (both p < 0.001). These improvements were sustained at six months (NRS: 2.86 ± 0.80 vs. 6.54 ± 1.99; ODI: 15.37 ± 3.99 vs. 33.70 ± 9.95; both p < 0.001). MRI changes were more frequent in the PRP group (73.09% vs. 9.28%, p < 0.001); however, these findings should be considered exploratory due to potential selection bias in imaging follow-up. Conclusions: PRP injection was associated with greater improvements in pain and function than conservative treatment. MRI improvements were more frequent in the PRP group, but these findings remain exploratory. Full article

Background: Lower limb (LL) and low back Radicular Syndromes (RSs) may result from discopathy of the lumbo-sacral spine. Consistent benefits are reported from Epidural Adhesiolysis (EA). Aim: To evaluate clinical and European Quality of Life items (EQ-5D) of Peri-Neural Release interventions (PNR, a modified approach and terminology for EA) among patients diagnosed with lumbo-sacral discopathy associated radicular syndromes. Methods: A retrospective study was conducted by retrieving records of patients e treated by PNR for low back and lower limbs pain between January 2018 and December 2024. Eligible patients were adults who were diagnosed with lumbo-sacral discopathy, stenosis, or Post Lumbar Surgery Syndrome (PLSS). Data on Patient-Reported Outcome Measures (PROMs) adopting the European Quality of Life five items (Euro-QoL 5D) that includes self-ratings of mobility, active daily living, self-care, pain and discomfort, anxiety and depression) was collected before the procedure and on subsequent follow-up visits. Other clinical outcomes included numerical pain rating scales (NRSs), sleep quality, time to pain during activity, and self-reported health scores. Results: A total of 221 patients were included in this analysis. Of these, 56.6% were female, with a mean age of 45.1 ± 14.7 years. In total, 50.2% of patients underwent PNR alone, followed by 28.1% who underwent PNR balloon decompression neuroplasty. Of the remaining patients, 7.2% underwent epiduroscopic PNR, 6.3% PNR combined with annuloplasty (biacuplasty) and 8.1% underwent PNR combined with nucleoplasty. Significant improvements were observed across all EQ-5D and NRS (p < 0.001) at follow-up assessments without major complications. The interventions were associated with a decrease in NRS from 7.9 to 3.1, and an increase in the duration of pain-free activity (walking, standing, sitting) (p < 0.001). Self-reported overall health scores improved from 53.9 ± 18.4 to 81.1 ± 15.1. In terms of complications, two patients reported post-operative headache. The remaining side effects included coccydynia at the site of intervention, resolving with application of non-steroid anti-inflammatory topicals and self-resolving lower limb numbness in five cases. Conclusions: The presented data suggest that PNR—whether performed alone or in combination with adjunctive intradiscal procedures—is a safe intervention, and is associated, in the majority of patients, with substantial pain relief and improvement in EQ-5D both in the short- and long-term follow-up. Full article

Lumbar intervertebral disc herniation is a common cause of low back and radicular leg pain, traditionally managed with a combination of conservative therapies and, when indicated, surgical discectomy. An intriguing phenomenon observed in many patients is the spontaneous resorption of herniated disc material over time, often correlating with significant symptom improvement. This article is presented as a narrative review synthesizing experimental, imaging, and clinical literature relevant to spontaneous disc resorption and its implications for clinical decision-making. This paper provides a comprehensive overview of spontaneous disc herniation resorption, exploring the underlying pathophysiological mechanisms and the factors that predict which herniations are likely to regress without surgery. Key mechanisms include inflammatory-mediated degradation of disc fragments, neovascularization with macrophage infiltration and phagocytosis of extruded nucleus pulposus tissue, and biological processes such as enzymatic matrix breakdown and cellular apoptosis that collectively lead to shrinkage of the herniated mass. Patient and disc characteristics that favour spontaneous resorption are identified, such as younger age, extruded or sequestered fragment type, larger initial herniation size, and robust inflammatory response on imaging, whereas certain chronic degenerative changes may reduce this likelihood. We also review current clinical guidelines and expert recommendations on when surgical intervention is warranted versus when conservative management and observation are appropriate. Understanding the probability of natural disc fragment resolution is critical in guiding treatment decisions. In the absence of severe neurological deficits or intractable pain, a period of non-operative management can often be pursued safely, given that the majority of patients experience substantial relief within a few months as discs regress. Conversely, timely surgery is advised for those with neurological compromise or refractory symptoms. By synthesizing the latest evidence on spontaneous disc herniation resorption and its predictors, this review aims to assist neurosurgeons and spine specialists in optimizing patient selection for conservative care and identifying the proper timing for surgical intervention to achieve the best clinical outcomes. Given the narrative design, conclusions are based on synthesis of heterogeneous evidence rather than formal comparative analysis. Full article

Background: Neuropathic pain represents a substantial global burden with limited effective therapeutic options. Pulsed Electromagnetic Field (PEMF) therapy has emerged as a potential non-invasive adjuvant, though clinical evidence remains inconsistent. This systematic review and meta-analysis evaluated PEMF efficacy and safety, specifically analyzing the influence of etiology and stimulation parameters. Methods: Following PRISMA 2020 guidelines (PROSPERO: CRD420251184151), five databases (Cochrane, PubMed, Scopus, Web of Science, and LILACS) were searched for Randomized Controlled Trials (RCTs) comparing PEMF versus sham. Risk of bias was assessed via Cochrane RoB 2, and heterogeneity was explored through detailed subgroup analyses. Results: Thirteen RCTs met the inclusion criteria (N = 688). While global analysis indicated a statistically significant pain reduction (SMD: −1.01; p = 0.03), it exhibited extreme statistical heterogeneity (I² = 92.8%) and instability. After adjusting for missing studies using the Trim-and-Fill method, global significance disappeared. However, subgroup analysis resolved this inconsistency, revealing a massive, clinically meaningful effect in Spinal/Radicular pain (SMD: −2.35; 95% CI: −4.42 to −0.29), whereas Peripheral Neuropathy showed no significant reduction (SMD: −0.38; 95% CI: −0.86 to 0.10). Conclusions: The PEMF evidence base for neuropathic pain is currently highly fragmented. Extreme heterogeneity and publication bias render “one-size-fits-all” efficacy estimates invalid and potentially misleading. Instead, our data reveals a critical etiological divergence: PEMF appears highly effective for spinal/radicular pathology, likely due to the mechanical nature of the lesion, but demonstrates limited efficacy for diffuse peripheral neuropathy. Future research must abandon generic protocols in favor of etiology-specific trials, prioritizing high-frequency parameters and rigorous bias control. Full article

Background/Objectives: Fluoroscopically guided cervical nerve root corticosteroid injections are used for the treatment and diagnosis of radicular pain. Including a local anesthetic with the injected corticosteroid may decrease the pain associated with the procedure and add immediate diagnostic value. However, little is known about the safety of including a local anesthetic with a corticosteroid in these injections. Methods: A total of 299 consecutive cervical nerve root injections, performed between 2016 and 2024, were reviewed. Demographic and injection information (level/laterality and inclusion/exclusion of 1% preservative-free lidocaine with dexamethasone injectate) were documented. Charts were reviewed for major complications and increased pain post-procedure. Categorical data were compared between groups using Fisher’s exact test or Chi-square testing. Results: Injections were performed with 10 mg of dexamethasone only in 263 cases and with a mixture of 10 mg of dexamethasone and 1 mL of 1% lidocaine in 36 cases. There was no statistically significant difference in the incidence of major complications (p ≈ 1) or immediately increased pain post-procedure (p = 0.799). Conclusions: With proper technique, there is no evidence from this case–control study or in the available literature to suggest that including lidocaine with corticosteroid increases risks associated with cervical nerve root injections. However, serious adverse events are theoretically possible with injection of local anesthetic into a radicular artery, the vertebral artery, or subdural space. Given that such risks are not associated with the use of non-particulate steroids alone, large multi-institutional studies are needed to draw confident conclusions on the risks and benefits of the inclusion of local anesthetics with non-particulate corticosteroids for cervical transforaminal epidural steroid injection to inform clinical practice. Full article

Corticosteroid receptor signaling in primary afferent neurons of the dorsal root ganglion (DRG) has emerged as a potential target to modulate nociception via genomic and nongenomic mechanisms shown in animal pain models. However, the expression landscape of glucocorticoid receptors (GRs) relative to mineralocorticoid receptors (MRs) in human DRG, their association with pain-related markers, and their functional relevance remain incompletely defined. We analyzed human and rat DRG by mRNA profiling and immunofluorescence confocal microscopy to assess GR/MR expression and complemented these studies with a clinical evaluation of neuraxial corticosteroid delivery. Here, GR transcripts in human DRG were the most abundant among corticosteroid receptor-related genes examined (including MR) and were observed alongside transcripts of pain-signaling molecules. Human DRG immunofluorescence analysis revealed substantial colocalization of GR with calcitonin gene-related peptide (CGRP), a marker of nociceptive unmyelinated C-fibers and thinly myelinated Aδ-fibers, as well as with gial fibrillary acidic protein (GFAP), a marker of satellite glial cells (SGCs), but minimal expression in myelinated neurofilament 200 (RT-200) immunoreactive (IR) human DRG neurons. In addition, GR immunoreactivity was primarily distributed to medium-diameter neurons (40–65 µm). Functionally, preclinical experiments showed that GR activation and MR blockade attenuate inflammatory pain via rapid, nongenomic neuronal mechanisms that counter an intrinsic mineralocorticoid receptor-mediated pronociceptive drive. Consistently, clinical analgesia over at least 3 months after transforaminal plus caudal epidural delivery of GR agonists in chronic radicular pain supports a functional role for neuronal GR signaling within spinal cord and DRG circuits. Together, these molecular, functional, and clinical findings identify GR as a key modulator of sensory neuron excitability and pain, highlight MR as a pronociceptive counterpart, and suggest that selectively enhancing GR signaling or inhibiting MR signaling may offer a potential strategy for improving corticosteroid-based analgesic therapies. Full article

Background/Objectives: Following lumbar fusion procedures, adjacent segment degeneration (ASD) at cranial levels presents as a well-documented long-term complication, manifesting through recurrent pain, neurological deficits, and progressive functional decline. The prone single-position technique for lateral lumbar interbody fusion (PSP-LLIF) streamlines surgical workflow by eliminating the need for intraoperative patient repositioning; however, comprehensive evidence supporting its clinical and radiological effectiveness in managing cranial ASD remains insufficient. Material and Methods: This retrospective cohort study examined 30 consecutive patients presenting with symptomatic cranial adjacent segment disease who were treated with PSP-LLIF at a single institution. Patient-reported outcome measures included visual analog scale (VAS) assessments for axial and radicular pain, alongside the Oswestry Disability Index (ODI) for functional status evaluation. Radiological parameters included overall and segmental lumbar lordotic measurements, anterior and posterior disk height, fusion status, and instrumentation-related complications. Results: At 12-month postoperative evaluation, substantial clinical improvements were demonstrated. Mean VAS reductions measured 4.7 points for axial pain and 6.5 points for radicular pain, while ODI decreased by 28.5 points (p < 0.05). Radiological assessment demonstrated mean increases of 6.3° in lumbar lordosis and 5.1° in segmental lordosis, along with significant gains in both anterior and posterior disk height (p < 0.05). Solid fusion was radiographically confirmed at all instrumented levels. Temporary postoperative neurological symptoms developed in several patients but resolved spontaneously without requiring revision surgery. Conclusions: PSP-LLIF yields substantial clinical benefit and reliable radiological correction in patients with symptomatic cranial ASD. Optimal outcomes necessitate rigorous adherence to position-specific technical modifications, particularly maintenance of perpendicular fluoroscopic trajectories and implementation of continuous neural monitoring to account for prone-induced anatomical shifts. This approach represents a viable treatment strategy for patients with symptomatic cranial ASD. Full article

Background/Objectives: The optimal duration of pulsed radiofrequency (PRF) applied to the dorsal root ganglion (DRG) remains unclear, particularly in patients with chronic lumbosacral radicular pain (LRP) who are unresponsive to conservative therapy. Although preclinical data suggest duration-dependent neuromodulatory effects, comparative clinical evidence for specific exposure times is limited. This study aimed to evaluate the outcomes of 4 min and 8 min DRG-targeted PRF applications performed in combination with transforaminal epidural steroid injection (TFESI) in patients with chronic LRP unresponsive to conservative treatment, to determine whether prolonged exposure provides superior analgesic and functional outcomes. Methods: In this prospective, single-center, observational comparative study, 72 patients with chronic lumbar radicular pain (LRP) refractory to conservative management received DRG-targeted PRF using standardized parameters (45 V, 20 ms, 2 Hz, ≤42 °C). Participants underwent either 4 min (n = 36) or 8 min (n = 36) PRF, assigned according to clinical discretion. All procedures were followed by transforaminal epidural injection of dexamethasone and bupivacaine. The primary endpoint was Numeric Rating Scale (NRS) pain intensity at 6 months. Secondary endpoints included Oswestry Disability Index (ODI), patient satisfaction, responder rates, and analgesic use across 1-, 3-, and 6-month follow-up. Results: Both groups achieved significant improvements from baseline at all time points. Linear mixed-effects analysis demonstrated a significant overall association favoring the 8 min protocol for pain (estimate: −0.81, 95% CI: −1.52 to −0.10, p = 0.025) and functional disability (estimate: −12.84, 95% CI: −19.36 to −6.32, p < 0.001). Functional benefits emerged by 3 months (p = 0.006), while pain reduction reached borderline statistical significance at 6 months (p = 0.048). The 8 min group showed numerically higher responder rates and patient satisfaction without increased adverse events. Conclusions: In this study evaluating a combined PRF and corticosteroid injection protocol, 8 min PRF exposure was associated with superior pain and functional outcomes compared to 4 min, without compromising safety. However, the observational design and concurrent medication administration limits causal inference. Randomized controlled trials are needed to confirm these findings and isolate the independent effect of PRF duration. Full article

Low-back pain (LBP) is a leading cause of disability worldwide. When symptoms persist beyond 4–6 weeks, when red flags are suspected, or when precise patient selection for procedures is needed, imaging—primarily MRI (Magnetic Resonance Imaging)—becomes pivotal. The purpose is to provide a pragmatic, radiology-first roadmap that aligns an imaging phenotype with anatomical targets and appropriate image-guided interventions, integrating MRI-based phenotyping with image-guided interventions for subacute and chronic LBP. In this narrative review, we define operational MRI criteria to distinguish radicular from non-radicular phenotypes and to contextualize endplate/Modic and facet/sacroiliac degenerative changes. We then summarize selection and technique for major procedures: epidural and periradicular injections (including selective nerve root blocks), facet interventions with medial branch radiofrequency ablation (RFA), sacroiliac joint injections and lateral branch RFA, basivertebral nerve ablation (BVNA) for vertebrogenic pain, percutaneous disc decompression, minimally invasive lumbar decompression (MILD), and vertebral augmentation for painful fractures. For each target, we outline preferred and alternative guidance modalities (fluoroscopy, CT, or ultrasound), key safety checks, and realistic effect sizes and durability, emphasizing when to avoid low-value or poorly indicated procedures. This review proposes a phenotype-driven reporting template and a care-pathway table linking MRI patterns to diagnostic blocks and definitive image-guided treatments, with the aim of reducing cascade testing and therapeutic ambiguity. A standardized phenotype → target → tool approach can make MRI reports more actionable and help clinicians choose the right image-guided intervention for the right patient, improving outcomes while prioritizing safety and value. Full article

Background/Objectives: Transforaminal epidural steroid injection (TFESI) is widely used to treat lumbosacral radicular pain caused by a herniated lumbar disc (HLD). However, therapeutic response varies substantially, and reliable outcome prediction remains challenging because of the multifactorial interplay of clinical and morphological factors. Machine learning (ML) approaches may address this limitation by modeling nonlinear interactions among patient-specific variables. Methods: This retrospective cohort study analyzed 242 patients with HLD-related radiculopathy who underwent single-level lumbar TFESI. Eight variables—age, sex, injection side, injection level, pain duration, pretreatment numeric rating scale (NRS) score, HLD location, and HLD subtype—were used as input features. Therapeutic outcome was defined as a ≥50% reduction in NRS score at 1 month after TFESI. Three predictive models, namely deep neural network (DNN), random forest (RF), and XGBoost, were developed and evaluated using a validation cohort of 49 patients. Results: The DNN model demonstrated the best validation performance, achieving an area under the curve (AUC) of 0.821 (95% confidence interval [CI], 0.690–0.929). The performance of the RF (AUC, 0.711; 95% CI, 0.535–0.865) and XGBoost (AUC, 0.674; 95% CI, 0.498–0.831) models was inferior to that of the DNN. In addition, the DNN produced fewer false-positive predictions and showed more robust discrimination between favorable and poor outcomes than the other ML models. Conclusions: A deep learning–based predictive model demonstrated superior performance in predicting therapeutic outcomes after lumbar TFESI in patients with HLD-related radiculopathy. Integration of routine clinical and magnetic resonance imaging (MRI)-derived features into ML algorithms may enhance individualized prognostication and assist clinicians in optimizing patient selection for interventional procedures. To the best of our knowledge, this is the first study to develop an ML-based model integrating routine clinical variables with MRI findings for the prediction of TFESI outcomes in HLD-related radiculopathy. Nevertheless, the study is limited by its single-center retrospective design, lack of external validation, and reliance on MRI assessments performed by a single rater. Future multicenter studies are warranted to improve generalizability and confirm clinical utility. Full article

Background and Objectives: Lumbar interlaminar ventral epidural injection (LIVEI) offers a promising alternative to transforaminal epidural injection (TFEI) by enabling ventral epidural delivery while minimizing complication risks. While previous approaches often required catheter assistance, this pilot study evaluates the safety, technical feasibility, and early outcomes of a simplified LIVEI method at L5–S1 without catheter insertion. Materials and Methods: Twelve patients with lumbosacral radicular pain received unilateral catheter-free LIVEI at L5–S1 between October 2021 and September 2022. This small retrospective pilot cohort did not include a control group. Contrast spread patterns were evaluated fluoroscopically based on AP and lateral views. Spread was classified into three grades depending on anterior epidural distribution, cranio-caudal extent, and foraminal involvement. Visual Analog Scale (VAS) scores were assessed before and two weeks after the procedure. Spread was classified into three grades depending on anterior epidural distribution, cranio-caudal extent, and foraminal involvement. Results: Fluoroscopic images confirmed ventral epidural spread in all patients, with 75% showing foraminal extension and 67% demonstrating cranio-caudal spread over two or more levels. Baseline VAS scores averaged 6.5 ± 1.0, decreasing to 3.42 ± 1.31 two weeks post-procedure (p < 0.0001), with a mean reduction of 3.08 ± 1.00. No adverse events or complications were observed. Conclusions: Catheter-free LIVEI at the L5–S1 level demonstrated consistent anterior and multi-level ventral epidural contrast distribution on fluoroscopy, supporting the technical feasibility of this approach. In addition to this radiographic validation, patients achieved clinically meaningful pain relief with excellent tolerability. Further confirmation through larger-scale controlled studies is warranted to validate long-term clinical effectiveness. Full article