Epidural varicosis as a possible cause of radicular pain: a case report

Abstract

IntroductionThe incidence rate of epidural varicosis has declined by 0.07% to 1.2% since the introduction of computed tomography and magnetic resonance imaging. Despite the use of these modern imaging methods it can still be difficult to distinguish the diagnosis of epidural varicosis from other causes, such as nucleus pulposus prolapse.Case presentationWe present the case of a 48-year-old Caucasian woman who had been experiencing sciatic pain for seven years. A physical examination showed nerve root pain at L5 on the right side, with positive signs of neurotension. During an elective hysterectomy due to endometriosis, unusually pronounced varicosis in her lesser pelvis was seen that had not previously been detected. Postoperatively, our patient developed a symptomatic pulmonary embolism. Findings from magnetic resonance tomography of her lumbar spine, in conjunction with our patient's history, were considered by the radiologist to be indicative of epidural varicosis. No further pathological abnormalities that could have been the cause of the nerve root pain were found.ConclusionsIn cases of epidural varicosis with irritation of neural structures as a result of inferior vena cava hypoplasia, surgical treatment leads to unsatisfactory results. Significantly better results can be achieved by resolving the cause of the vena cava pathology. In cases of hypoplasia or aplasia of the inferior vena cava this is not always possible; consequently, as in the case of our patient, only a symptomatic therapy in combination with an anticoagulant and compression therapy can be performed.

Lumbar Epidural Varix Mimicking Disc Herniation

“…Lumbar epidural varices may mimic lumbar disc herniation by causing radiculopathy 2 13) . In various publications, the incidence rate of lumbar epidural varices was reported as 0.067–1.2% 6) . The diagnosis of this entity is usually made intraoperatively.…”

Neurogenic claudication without spinal stenosis arising as a result of lumbar epidural varices

“…3 Dilated epidural venous plexuses have been reported to mimic the presentation of lumbar disc prolapse, 3,7,8 and acute cauda equina syndrome as a result of epidural venous engorgement has also been described. 9 Although commonly found in the lumbar spine, symptomatic epidural varices have been reported in the cervicothoracic region.…”

Severe lumbar radiculopathy with epidural venous plexus engorgement in a morbidly obese pediatric patient

“…However, vascular abnormalities causing compression and excessive pressure on a nerve root and/or dorsal root ganglion have occasionally been reported. [6,7,8] These abnormalities may give rise to symptoms similar to lumbar disc herniation or spinal stenosis. The exact diagnosis can often be delayed.…”

“…The exact diagnosis can often be delayed. The reported incidence of lumbar epidural varices ranges from 0.07% to 1.2% [8] . The causes of spinal radiculopathy include vascular malformation, thrombosis of the iliac vein, superior vena cava, or inferior vena cava, Budd–Chiari syndrome, intracranial hypotension, pregnancy, and portal hypertension.…”