DOI QR코드

DOI QR Code

Lumbar Epidural Varix Mimicking Disc Herniation

  • Received : 2015.06.19
  • Accepted : 2015.12.10
  • Published : 2016.07.01

Abstract

Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4-5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method.

Keywords

References

  1. Akutsu H, Sugita K, Sonobe M, Matsumura A : A case of nontraumatic spinal epidural hematoma caused by extradural varix : consideration of etiology. Spine J 3 : 534-538, 2003 https://doi.org/10.1016/S1529-9430(03)00153-0
  2. Aoyama T, Hida K, Akino M, Yano S, Saito H, Iwasaki Y : Radiculopathy caused by lumbar epidural venous varix : case report. Neurol Med Chir (Tokyo) 48 : 367-371, 2008 https://doi.org/10.2176/nmc.48.367
  3. Bakar B, Tekkok IH : Lumbar periradicular abscess mimicking a fragmented lumbar disc herniation : an unusual case. J Korean Neurosurg Soc 44 : 385-388, 2008 https://doi.org/10.3340/jkns.2008.44.6.385
  4. Campbell DN, Liechty RD, Rutherford RB : Traumatic thrombosis of the inferior vena cava. J Trauma 21 : 413-415, 1981 https://doi.org/10.1097/00005373-198105000-00018
  5. Dickman CA, Zabramski JM, Sonntag VK, Coons S : Myelopathy due to epidural varicose veins of the cervicothoracic junction. Case report. J Neurosurg 69 : 940-941, 1988 https://doi.org/10.3171/jns.1988.69.6.0940
  6. Endres S : Epidural varicosis as a possible cause of radicular pain : a case report. J Med Case Rep 5 : 537, 2011 https://doi.org/10.1186/1752-1947-5-537
  7. Genevay S, Palazzo E, Huten D, Fossati P, Meyer O : Lumboradiculopathy due to epidural varices : two case reports and a review of the literature. Joint Bone Spine 69 : 214-217, 2002 https://doi.org/10.1016/S1297-319X(02)00376-7
  8. Hanley EN Jr, Howard BH, Brigham CD, Chapman TM, Guilford WB, Coumas JM : Lumbar epidural varix as a cause of radiculopathy. Spine (Phila Pa 1976) 19 : 2122-2126, 1994 https://doi.org/10.1097/00007632-199409150-00022
  9. Kim KH, Song SW, Lee SE, Lee SH : Spinal epidural arteriovenous hemangioma mimicking lumbar disc herniation. J Korean Neurosurg Soc 52 : 407-409, 2012 https://doi.org/10.3340/jkns.2012.52.4.407
  10. Lee YS, Choi ES, Kim JO, Ji JH : A rare calcified thrombosis of the dilated epidural venous plexus presenting with lumbar radiculopathy : a case report. Spine J 11 : e28-e31, 2011 https://doi.org/10.1016/j.spinee.2010.12.016
  11. Paksoy Y, Gormus N : Epidural venous plexus enlargements presenting with radiculopathy and back pain in patients with inferior vena cava obstruction or occlusion. Spine (Phila Pa 1976) 29 : 2419-2424, 2004 https://doi.org/10.1097/01.brs.0000144354.36449.2f
  12. Pekindil G, Yalniz E : Symptomatic lumbar foraminal epidural varix. Case report and review of the literature. Br J Neurosurg 11 : 159-160, 1997 https://doi.org/10.1080/02688699746546
  13. Pennekamp PH, Gemund M, Kraft CN, von Engelhardt LV, Luring C, Schmitz A : [Epidural varicosis as a rare cause of acute radiculopathy with complete foot paresis--case report and literature review]. Z Orthop Ihre Grenzgeb 145 : 55-60, 2007 https://doi.org/10.1055/s-2007-960503
  14. Slin'ko EI, Al-Qashqish II : Surgical treatment of lumbar epidural varices. J Neurosurg Spine 5 : 414-423, 2006 https://doi.org/10.3171/spi.2006.5.5.414
  15. Wong CH, Thng PL, Thoo FL, Low CO : Symptomatic spinal epidural varices presenting with nerve impingement : report of two cases and review of the literature. Spine (Phila Pa 1976) 28 : E347-E350, 2003 https://doi.org/10.1097/01.BRS.0000090500.10184.7A
  16. Zimmerman FA, Weingarten K, Lavyne MH : Symptomatic lumber epidural varices. Report of two cases. J Neurosurg 80 : 914-918, 1994 https://doi.org/10.3171/jns.1994.80.5.0914

Cited by

  1. Severe lumbar radiculopathy with epidural venous plexus engorgement in a morbidly obese pediatric patient : A case report vol.98, pp.33, 2016, https://doi.org/10.1097/md.0000000000016842
  2. Engorged venous plexus mimicking adjacent segment disease: Case report and review of the literature vol.11, pp.None, 2020, https://doi.org/10.25259/sni_166_2020
  3. Radiculopathy caused by lumbar epidural varix vol.13, pp.2, 2016, https://doi.org/10.18700/jnc.200029
  4. Gastric balloon: A rare cause of lumbar radiculopathy vol.12, pp.None, 2016, https://doi.org/10.25259/sni_656_2021