Ultrasound-Guided Epidural Caudal Block for Lumbar Spinal Stenosis in a Patient with Severe Scoliosis: A Case Report

Background: Lumbar spinal stenosis (LSS) is a common degenerative condition in the elderly characterized by narrowing of the spinal canal that leads to neural compression and symptoms such as low back pain, neurogenic claudication, and sensory disturbances. LSS may coexist with degenerative lumbar scoliosis (DLS), which can further complicate clinical presentation and management. While surgical treatment is often considered for severe cases, nonsurgical interventions remain important treatment options, particularly for elderly patients with comorbidities. Case Presentation: We report the case of a 69-year-old male presenting with chronic low back pain for more than two years, accompanied by radiating pain, numbness, and tingling in the lower extremities. Physical examination and radiographic evaluation revealed thoracolumbar scoliosis with a Cobb angle of 44° and findings consistent with lumbar spinal stenosis. The patient underwent an ultrasound-guided caudal epidural injection consisting of lidocaine and dexamethasone. Immediately after the procedure, the patient reported complete pain relief (NRS 0/10) and improvement of paresthesia. A comprehensive rehabilitation program including Williams flexion exercises, Transcutaneous Electrical Nerve Stimulation (TENS), and Microwave Diathermy (MWD) was initiated. At one-week follow-up, the patient remained pain-free with improved function, allowing gradual tapering and discontinuation of tramadol and pregabalin. At six-month follow-up, the patient remained symptom-free without recurrence. Conclusion: Ultrasound-guided caudal epidural injection combined with rehabilitation may provide an effective, minimally invasive treatment option for patients with lumbar spinal stenosis and concomitant scoliosis.