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

Abstract

Introduction:Engorgement of the epidural venous plexus (EVP) is a rare cause of nerve root impingement. Dilated epidural veins cause compression of the thecal sac and spinal nerve roots, leading to lumbar radiculopathy.Patient concerns:Here we describe a case of severe lumbar radiculopathy in a 15-year-old morbidly obese boy.Diagnosis:Enhanced lumbar magnetic resonance imaging revealed left sided L1–L2 disc protrusion and engorgement of the lumbar EVP, resulting in narrowing of the thecal sac in the entire lumbar spine. There was no evidence of an intra-abdominal mass, thrombosis of the inferior vena cava, or vascular malformation.Interventions:A caudal epidural block was administered under fluoroscopic guidance. The patient reported a 30% reduction in pain intensity for just 1 day.Outcomes:The patient has been followed up for 2 years. He continues to take medication, including morphine sulfate 15 mg, gabapentin 300 mg, and oxycodone 20 mg per day. He is on a diet with exercise for weight reduction.Conclusion:An engorged EVP should be considered in the differential diagnosis of radiculopathy in morbidly obese patients.

Spinal Epidural varicosity resembling prolapsed intervertebral disc on MRI: A diagnostic dilemma for lumbar canal stenosis

“…Type C is conditions in which varices are encircled around the nerve root and compressing the nerve root. 3 As in our case, the preoperative diagnosis was presumed a case of canal stenosis due to centrally herniated disc at L5-S1 level by history, clinical examinations & radiological investigations. Patient was planned for conventional discectomy at L5/S1 level on torso flat prone position with torso on hall frame, abdomen hanging free & hip flexed.…”

“…& neurogenic claudication. [1][2][3][4] Epidural venous plexus enlargement, presenting with low back pain and radiculopathy, is an uncommon cause of nerve roots impingement. This condition commonly mimics a herniated nucleus pulposus radiologically.…”

Engorged venous plexus mimicking adjacent segment disease: Case report and review of the literature

“…[1,13] EVPs are variously attributed to: vascular anomalies such as IVC thrombosis/ hypoplasia, iliac vein stenosis, obesity related IVC obstruction, bladder distention, intracranial hypotension, previous microdiscectomy, coagulopathy, Factor V Leiden mutation, protein C deficiency, Behcet's, and Budd-Chiari syndrome. [18,22] ese conditions block normal venous drainage into or through the IVC, and divert blood flow into collaterals through the vertebral venous plexus; this results in venous engorgement and compression of the thecal sac, nerve roots, or cauda equine. [22] Encountering unanticipated EVPs during lumbar surgery…”

“…Although rare, clinicians should consider EVPs in their differential diagnosis when encountering patients with radiculopathy who also have a history of obesity, vascular conditions, current pregnancy, or are taking oral contraceptives. [18,21,22] Where EVPs are discovered intraoperatively, surgical decompression utilizing electrocautery or hemostatic techniques should be performed to relieve neural compression and radiculopathy. [2,14,15,26] However, avoiding rupture of these vessels is critical as this can contribute to marked increase difficulty in obtaining hemostasis.…”

Gastric balloon: A rare cause of lumbar radiculopathy

“…There are multiple causes of engorgement of the lumbar epidural venous plexus (EVP); including inferior vena cava (IVC) obstruction; portal hypertension, vascular agenesis, morbid obesity, pregnancy, intra-abdominal mass, Budd-Chiari syndrome, or hypercoagulable states. [ 1 , 6 ]…”