Thoracolumbar pain associated with cervical radiculopathy successfully managed with combined cervical periradicular injection and ultrasound-guided percutaneous electrical nerve stimulation therapy: a case report.

BACKGROUND: Cervical radiculopathy may occasionally present with atypical pain patterns extending beyond the classical cervical and upper-limb distribution, potentially leading to diagnostic uncertainty. The thoracodorsal nerve originates predominantly from the C6-C8 roots and innervates the latissimus dorsi muscle, providing a possible anatomical basis for referred pain involving the posterior thoracolumbar region. This case describes an unusual presentation of cervical radiculopathy manifesting predominantly as severe thoracolumbar pain and its management using a combined interventional approach.

CASE DESCRIPTION: A 74-year-old woman presented with a 3-month history of severe right thoracolumbar pain, localized hyperalgesia, and painful myofascial tenderness involving the latissimus dorsi region. Baseline pain intensity was 8/10 on the numerical rating scale (NRS), with associated limitation of trunk mobility and sleep interruption. Previous pharmacological and rehabilitative treatments had failed to provide clinically significant improvement. Cervical magnetic resonance imaging (MRI) demonstrated multilevel degenerative disc disease with right-sided foraminal stenosis involving the C6-C7 and C7-T1 levels. Ultrasound-guided periradicular steroid injections at the right C6, C7, and C8 levels produced significant pain reduction within 48 hours. Subsequently, two sessions of ultrasound-guided percutaneous electrical nerve stimulation (PENS) targeting the presumed thoracodorsal nerve pathway were performed over a 2-month period. At follow-up, pain intensity decreased to NRS 2/10, with improvement in trunk mobility and daily activities. No complications or adverse events were observed.

CONCLUSIONS: This case highlights the importance of considering a possible cervical origin in selected patients presenting with otherwise unexplained thoracolumbar pain. The favorable clinical course observed after cervical periradicular injections followed by ultrasound-guided PENS suggests that this combined approach may represent a minimally invasive therapeutic strategy in selected patients with refractory cervicogenic thoracolumbar pain. Further studies are required to clarify the underlying mechanisms and determine the specific contribution of PENS to the observed clinical improvement.