A case report of May-Thurner syndrome induced by anterior lumbar disc herniation

Abstract

Rationale: Lumbar degeneration-related May-Thurner syndrome (dMTS) is characterized by venous compression induced by degenerated lower lumbar structures. Treatment strategies for May-Thurner syndrome (MTS) include clearing the thrombus and correcting venous compression. Despite having different etiological factors from other MTS types, treatments for dMTS are similar, including endovascular angioplasty and continuous anticoagulation therapies. Thus, a particular treatment was designed herein to focus on compressive lumbar structures instead of intravenous management. Patient concerns: A 59-year-old female patient with dMTS, which was induced by inferior vena cava (IVC) stenosis compressed by L4-5 anterior disc herniation. Diagnosis: The patient was diagnosed with IVC stenosis and L4-5 lumbar disc herniation based on abdominal computed tomography, ultrasound, and lumbar magnetic resonance imaging findings. Interventions: Radiofrequency thermocoagulation (RF) was applied to the patient to decrease the compression caused by anterior disc herniation. Outcomes: After surgery, the patient's swelling started to improve within 5 hours and completely diminished after 48 hours. Postsurgical abdominal ultrasound showed that her IVC patency increased by 20%. On follow-up, her leg symptoms did not recur at 12 months after surgery. Lessons: We provided a novel idea in the treatment of dMTS, in which we shifted the treatment focus from endovascular patency restoration to extravascular decompression. Our case proved that RF was effective in treating dMTS, which is a complementary treatment modality to angioplasty.

The role of ultrasound imaging in vascular compression syndromes

“…In patients with acute thrombosis, however, direct trans-catheter thrombolysis is still performed [ 54 ]. Other types of intervention have recently been reported, such as "radiofrequency thermocoagulation" [ 55 ] not yet supported, however, by sufficient case studies.…”

Lumbar overlordosis — towards the better understanding of the May-Thurner syndrome pathogenesis

“…In most of the available reports concerning the clinical significance of the changes related to the vertebral column pathological, degenerative or traumatic conditions of the lumbar vertebras are mentioned [28][29][30][31][32][33][34][35]. This is in accordance with the fact of limited prevalence of MTS in a very young patient population where this pathology is very rarely observed.…”

“…Several changes related to the lumbar degeneration-related MTS could be identified including forward bulging or protruding of the intervertebral disc, osteophytes and spondylothesis [27]. In the literature, several case reports concerning the potential influence of vertebral degeneration changes or spinal/vertebral surgery on the symptomatic course of MTS can be identified, in most of the cases concerning significant vertebral column pathology [28][29][30][31][32].…”

Diagnostic Value of the Iliac Vein Stenosis Percentage Combined With Indicators of Venous Reflux for Iliac Vein Compression Syndrome With Computed Tomography Venography

“…Isotropic CT data sets allow robust postprocessing capabilities (eg, MPR, volume rendering, maximum intensity projection), which makes it easy to precisely identify the vascular structure of the pelvis 11 . Moreover, CTV can show the extravascular structures of the abdomen and pelvis, which is helpful for identifying iliac vein stenosis caused by other reasons 25–27 . Computed tomography venography is associated with radiation hazards and requires contrast agents, which can cause renal damage or allergic reactions.…”