Successful Return to Elite Competition following a Foraminal Block for Minimal Far-lateral Disc Herniation at L5-S1: A Report of 2 Cases.

Abstract

This report presents 2 cases demonstrating how a foraminal block served as both a diagnostic tool and an effective treatment for small far-lateral lumbar disc herniation at L5-S1 in elite athletes. The patients were a male swimmer in his early 20s and a female figure skater in her late teens, both of whom developed activity-related low back pain, with symptoms acutely exacerbated by the high flexion and extension loads inherent to their sports, which compromised their ability to compete at the highest level. A fluoroscopy-guided foraminal block was performed in each case; the key technical component was careful paraneural needle placement, stopping just short of the nerve root to minimize the risk of iatrogenic injury while targeting the inflammatory environment throughout the foramen. The diagnosis was confirmed in both athletes by reproducing their specific pain during injection. This non-operative intervention provided pain relief that was sufficient for successful participation in a major international competition in one case and continuation of a critical qualifying season for a premier global event in the other. This approach represents a critical diagnostic and therapeutic strategy that can avoid the need for surgery and preserve an elite athlete's immediate career goals.