Epidural steroid injections in the management of a patient with spinal stenosis and urinary urgency

A 79-year-old woman with a history of chronic back pain and urinary urgency presented to a spine center for treatment and evaluation for axial low back pain. The patient described the back pain as severe with intermittent radiation into the right leg; her pain intensity was 7 out of 10 on a visual analog scale. She described her sense of urgency as severe, and could delay urination for 10 min or less. She described her bladder control as 6 out of 10 on the urgency perception score (with 0 being perfect control).

Physical examination, including manual muscle testing, test for sensation to fine touch, reflex assessment and assessment of gait pattern, and MRI of the lumbar spine.

Overactive bladder associated with severe central-canal stenosis at L4-5, in the setting of anterolisthesis.

Fluoroscopically guided caudal epidural steroid injection; 60 mg of triamcinolone, 3 ml of 1% lidocaine hydrochloride and 3 ml of normal saline, injected in increments.