•84-year-old male with a past medical history of hypertension, chronic kidney disease, lumbar spondylosis, prostate cancer status post radiation in 2014, and avascular necrosis and osteoarthritis of the right hip status post THA in 2019 presented the Manhattan VA multiple times in 2023 for right hip pain.

•Pain management was consulted during his second hospital stay for intractable pain. He described pain in the Posterior Superior Illiac Spine (PSIS) area and groin with radiation to right thigh, stopping above the knee, described as “hot, burning, like a poker”.

•MRI demonstrated multilevel advanced degenerative disease with severe spinal stenosis seen at L2/3 and L4/5 as well as asymmetric atrophy and edema involving the right adductor musculature, including the obturator externus and internus, and atrophy of the right gluteus minimus and medius.

•EMG was concerning for bilateral polyneuropathy, Right L2-3 radiculopathy, Left L4 radiculopathy, and could not exclude the possibility of bilateral chronic lower lumbar radiculopathy.

•Patient received a transforaminal lumbar epidural steroid injection at the L2 and L3 levels for treatment of subacute radiculopathy. The patient reported immediate pain relief with improved range motion and activity tolerance.