Clinical Context
A typical patient is a 55-year-old with chronic, refractory lumbar radicular pain following prior lumbar spine surgery and multiple conservative treatments. The pain is neuropathic, localized to the lumbar/sacral nerve distribution, with diagnostic imaging confirming nerve root pathology and pain reproduction on targeted diagnostic blocks. The interventional pain physician schedules a percutaneous, image-guided neurolytic procedure targeting lumbar or sacral nerve roots to provide longer-term pain relief.
The clinical workflow includes pre-procedure evaluation (history, physical, informed consent, medication reconciliation, anticoagulation management), procedural planning with review of recent imaging (MRI/CT), and documentation of prior diagnostic nerve block responses. On the day of service the patient undergoes monitored anesthesia care or general anesthesia depending on comorbidities and procedure complexity. Under fluoroscopic or CT guidance the interventionalist advances a needle to the target lumbar or sacral neural structure and injects a neurolytic agent (for example, phenol or alcohol) to chemically ablate the pain-generating nerve fibers. Post-procedure monitoring occurs in a recovery area with neurological checks, pain assessment, and discharge instructions. Documentation includes indication, imaging guidance, neurolytic agent and volume, levels treated, type of anesthesia, informed consent, and post-procedure condition.