BACKGROUND: Superior hypogastric plexus (SHP) neurolysis is a well-established intervention for pelvic cancer pain; however, lumbosacral transitional vertebrae (LSTV) can present significant technical challenges during fluoroscopically guided procedures.

CASE REPORT: A 70-year-old patient with refractory pelvic pain secondary to advanced cervical cancer and LSTV underwent successful neurolysis of the SHP and ganglion impar. A modified transdiscal approach was performed under fluoroscopic guidance, following a detailed preprocedural imaging analysis to account for the anatomical variation.

CONCLUSIONS: This case demonstrates the feasibility of transdiscal SHP neurolysis in patients with complex spinal anatomy when guided by thorough anatomical understanding, meticulous planning, and refined technique. Clinicians must recognize the full spectrum of lumbosacral variations and adapt interventional strategies accordingly in complex spine scenarios.

KEYWORDS: Nerve block, cancer pain, chronic pain