Objective: This study aimed to compare the effects of transforaminal epidural steroid injection (TFESI) and interlaminar epidural steroid injection (ILESI) techniques on pain management, functional improvement, and neuropathic pain in patients diagnosed with lumbar disc herniation (LDH). Materials and Methods: This retrospective cohort included 124 patients who underwent epidural steroid injections between 2024 and 2025. Patients were divided into two groups according to the injection technique: TFESI and ILESI. Pain intensity was assessed using the visual analog scale (VAS), functional status with the Oswestry disability index (ODI), and neuropathic pain with the douleur neuropathique 4 (DN4) questionnaire. Patient satisfaction and injection-related complications were comprehensively reported. Assessments were performed at baseline and at the 1 st , 2 nd , 3 rd , and 6 th months post-injection. Results: In the TFESI group, VAS, ODI, and DN4 scores demonstrated significant reductions at all follow-up points (p<0.001). Patient satisfaction was notably higher in the TFESI group. Complication rates remained low in both groups, with no statistically significant difference (p=1.000). Conclusion: In patients with LDH, TFESI provides greater pain relief and functional improvement compared to the interlaminar approach. While both methods are safe, the transforaminal technique appears to be a more effective and targeted treatment option.

Background/Objectives: Stellate ganglion block (SGB) is an interventional technique frequently applied to manage pain associated with sympathetic dysfunction. This study aimed to evaluate the short-term clinical outcomes and tolerability of SGB in patients with different pain phenotypes. Methods: From 1 January 2024 through 1 March 2025, 96 patients who underwent fluoroscopy-guided SGB at a single center were retrospectively analyzed. The Oswestry Disability Index (ODI) was used to assess functional status, the SF-36 was applied to evaluate health-related quality of life, and the Visual Analog Scale (VAS) was employed to measure pain intensity. This study included baseline measurements and follow-up evaluations at 1, 3, and 6 months after the procedure. Results: Statistically significant improvements were observed in VAS, ODI, and SF-36 scores across all pain groups (p < 0.001). The largest median VAS reductions were observed in the migraine (4.0 [3.5–5.0]) and complex regional pain syndrome (CRPS) (3.7 [3.0–4.5]) groups, both exceeding the minimal clinically important difference (MCID). Patients with neuropathic and nociceptive pain showed smaller median reductions (3.4 [2.8–4.0] and 3.0 [2.5–3.8], respectively). The highest proportion of responders (≥50% VAS reduction) was noted in the migraine group (64.3%), while the lowest occurred in the nociceptive group (37.5%). Multivariate analysis identified pain phenotype as the only independent predictor of favorable outcomes, particularly in migraine and CRPS. Minor transient complications occurred in 9.4% of patients, all resolving spontaneously. Conclusions: SGB was well tolerated and associated with significant pain reduction and functional improvement. The observed clinical benefits may reflect mechanisms involving both peripheral and central sympathetic modulation. Larger multicenter prospective studies with extended follow-up are warranted to confirm these findings.

Background and Objectives: Chronic migraines are a disabling neurological disorder with limited response to preventive pharmacological treatments. Greater occipital nerve (GON)-targeted radiofrequency (RF) procedures have emerged as promising interventions, yet long-term comparative data between pulsed RF (PRF) and continuous-lesion RF (LesionRF) remain scarce. This study evaluated the 12-month efficacy and safety of PRF versus LesionRF. Materials and Methods: A single-center cohort of 211 patients with chronic migraine diagnosed by ICHD-3 criteria (PRF = 107; LesionRF = 104) was analyzed. All patients had a positive diagnostic block and ≥12 months of follow-up. Interventions were performed under ultrasound guidance with standardized protocols (PRF: 42 °C, 4 min, 45 V; LesionRF: 80 °C, 90 s). The primary outcome was a change in monthly migraine days (MMD), while secondary outcomes included responder rates (≥50% MMD reduction), pain intensity (VAS), functional outcomes (HIT-6, MIDAS), quality of life (SF-36, EQ-5D), medication use, retreatment, and complications. Results: Both groups improved, but LesionRF showed greater benefit. At 12 months, LesionRF achieved a larger MMD reduction (−4.8 days vs. PRF, p < 0.001), higher responder rates (83% vs. 65%, p = 0.01), and greater VAS decreases (−1.6, p < 0.001). Functional and quality-of-life scores improved more with LesionRF, with MIDAS reductions surpassing MCID and responder rates meeting PASS. Retreatment was less frequent with LesionRF (8% vs. 19%; HR 2.15, p = 0.037), and two LesionRF patients (1.9%) developed hematomas that resolved conservatively. Conclusions: Compared with PRF, LesionRF provided more sustained and clinically meaningful benefits for chronic migraines. Both approaches appeared to be safe, though confirmation in larger randomized trials is warranted.

Objectives: In this retrospective observational study, we aimed to evaluate sacral hiatus morphometry in detail using MRI and investigate whether morphometric parameters can predict the success of a caudal epidural block. We hypothesized that reduced hiatus width and altered morphometric features may increase the likelihood of block failure. Methods: MRI scans of 240 adult patients (mean age: 51 years; 50% female) were retrospectively analyzed at a single center. Hiatus height and width, canal depth, and sacrococcygeal angle were measured. Gender- and age-related differences were assessed. Multivariate regression and ROC curve analysis were used to determine predictive thresholds for block failure. Results: Hiatus height was slightly higher in women (16.97 ± 7.25 mm) than in men (15.99 ± 7.55 mm, p < 0.05, Cohen’s d = 0.25). The mean hiatus width was 9.9 ± 3.0 mm. Canal depth (5.9 ± 2.2 mm) and sacrococcygeal angle (40.8 ± 11.1°) did not differ significantly between genders (p > 0.05). A hiatus width threshold of 8 mm was identified as a predictor of block failure (AUC = 1.00, 95% CI 0.98–1.00), though this exceptionally high value should be interpreted cautiously due to the risk of overfitting in regard to a single-center cohort. Conclusions: MRI-based morphometric assessment of the sacral hiatus provides clinically relevant information. A narrow hiatus (<8 mm) is strongly associated with block failure, while other parameters showed limited predictive value. These findings are hypothesis-generating and require prospective, multicenter validation before clinical application.

Background: This study aimed to assess the prevalence of neuropathic pain in patients diagnosed with lumbar disc herniation and to examine the correlation between neuropathic pain and surgical intervention. Material and methods: We performed a retrospective cohort study involving 217 patients diagnosed with lumbar disc herniation who reported persistent low back pain from January to December 2023. We assessed the existence of neuropathic pain using the Douleur Neuropathique 4 (DN4) questionnaire. We evaluated pain severity using the Visual Analogue Scale (VAS). We categorized the patients into three groups: non-operated, operated without stabilization, and operated with stabilization. Results: The patients had a mean age of 45.09 ± 14.28 years, with 57.6% being male. A DN4 score of > 4 indicated that neuropathic pain was present in more than half (51.2%) of the patients. The prevalence of neuropathic pain was 32.8% in the non-operated cohort, 67.3% in the operated cohort without stabilization, and 85% in the operated cohort with stabilization. Age exhibited a positive link with neuropathic pain score (r = 0.16, p

Objectives: Calcaneal spur is an important cause of chronic pain that is resistant to conservative treatments and reduces quality of life. Nerve ablation techniques are widely used in chronic pain. This study aimed to investigate the short‐ and long‐term effects of radiofrequency thermocoagulation (RFT) and intralesional cryoablation (CA) on pain management, functional limitation, and ankle function in patients with calcaneal spurs. Materials and Methods: This study included 71 patients aged between 28 and 52 years (body mass index, 22.3–31.1) who were receiving chronic pain treatment. The patients were evaluated pre‐ and postoperatively using the visual analog scale, functional limitation, activity limitation, and American Orthopedic Foot and Ankle Society score. Results: VAS was measured as 1.2 ± 0.1 in the RFT group and 1.3 ± 0.2 in the CA group at 6 months. RFT yielded faster and more effective results in pain management and short‐term functional improvement ( p = 0.00002), whereas CA was superior to the former in terms of ankle function in the long term ( p = 0.0001). Conclusion: RFT and CA have different advantages. Thus, personalized treatment should be provided to each patient. Although our study was conducted retrospectively, prospective studies are needed to support our findings.