HY Kim, et al / Psoas Compartment Block in a Laterally Herniated Disc 117 reduction of femoral neck fracture [5], and applied in the pain reducing treatment of cancer patients [6]. The author encountered a 69 year old male patient who had gait abnormality with pain in the hip joint caused by a laterally herniated intervertebral disc at the L2/3 level, which compressed the right psoas muscle. In a short term monitoring follow up, a satisfactory effect of pain control was obtained through psoas compartment blockade, thus it is being reported for literature review. CASE REPORT A 69 year old male patient, with height at 172 cm and weight at 70 kg, visited the hospital with gait abnormality in his right leg and pain in the pelvic joint area, which had continuously continued since its occurrence two years ago. The patient had a history of undergoing low anterior re- section, radiation treatment, and chemotherapy four years prior for rectal cancer, and was taking insulin and oral hy- poglycemics for diabetes. Since two years ago, the pa- tient’s leg could not be straightened properly when walking and pain in the pelvic area occurred when there was sud- den movement. He had visited pain clinics, rehabilitation clinics, neurology, and orthopedics, but did not receive any specific diagnosis and had endured with the aid of physical and drug treatments. The degree of pain was 4-5/10 in the visual analog scale (VAS), and the symptoms were pain in the right pelvic joint when walking, and when lying down, the pubic area felt tight and painful when the leg was com- pletely straightened, with pain subsiding when the leg was bent. During the physical examination, the straight leg rais- ing test was 90/90, but there was pain in both thighs, and the Patrick test indicated that both sides were positive. The Ganslene test was also positive in both sides, but the pain was worse in the right. There was tenderness in the spinous process of L3, and there were no tender points in the facet joints. The patient also complained of tender- ness in sacroiliac joints, gluteus medius, and piriformis. In the magnetic resonance image (MRI), there were no meta- stasis or recurrence observed, but the disc between L2 and 3 had been herniated to the right and was pressing the right psoas (Fig. 1). Hence, the gait abnormality and pain was considered to be caused by the laterally herniated intervertebral disc that compressed the right psoas muscle, and so a right psoas compartment blockade was performed. First, the patient was laid prone and the skin was sterilized. Under C-arm guidance, the transverse processes of the L3 were confirmed and an approach was made with a 22-G Tuohy Ⓡ needle (ARROW , Arrow International Inc., USA). At the position where resistance ceased, was the location after the psoas muscle was observed with the contrast medium, which was shown when 0.25% levobupivacaine (ChirocaineⓇ, Abbott, Elverum, Norway) 10 ml and triamcinolone diac- etonide 5 mg were injected (Fig. 2). The patient stated that there were no effects from the drug therapy received at another hospital, so in order to discern the effects of the blockade no other particular oral medication was pre- scribed. When the patient visited the outpatient clinic one Fig. 1. Coronal (A) and axial (B) T1-weighted MR images show a L2-3 herniated intervertebral disc compressing right psoas muscle and osteophytes surrounding the disc (white arrows). (C) Lateral disc herniation is not seen on sagittal view of MR image. www.epain.org