Spinal Epidural Varices, a great Mimic of Intervertebral Disc Prolapse – A Case Series

 

What to Learn from this Article?

Clinical presentation of spinal epidural varices and their intraoperative management


Case Report | Volume 4 | Issue 4 | JOCR Oct-Dec 2014 | Page 3-5 | Raghavendra V, Haridas P, Kumar A, Ajith K.  DOI: 10.13107/jocr.2250-0685.212


Authors: Raghavendra .V[1],  Papanaik Haridas[1], Anand Kumar[1], Ajith. K[1]

[1] Department of Orthopaedic, PES Medical College, Kuppam, Chittore dist, Andra Pradesh-517425, India.

Address of Correspondence:

Dr. Raghavendra. V, Asst Professor, Dept of Orthopaedics, PES Medical college, Kuppam, Chittore dist, Andra Pradesh – 517425. India. Ph: 0809490994034, 0809886391760, Email: drraghavendrav@gmail.com


Abstract

Introduction: 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. The radiological diagnosis is often missed and the diagnosis is made during the surgery. We are hereby  presenting  2  such cases  of epidural  varices mimicking intervertebral disc prolapse with lumbar radiculopathy.

Case Report: Case 1: 43 yr old female presented with acute exacerbation of low back ache and significant right L5– S1 radiculopathy without neurological deficit. MRI reported as L5-S1 disc prolapse. Intra-operatively engorged dilated epidural vein seen compressing S1 nerve root. Associated Disc bulge removed and Coagulative ablation of the dilated epidural vein was performed Case 2: 45 year old male manual labourer presented with backache with left sided sciatica since 8 months, increased in severity since past 1month associated with sensory blunting in   L5 and S1 dermatomes. Neurologic examination revealed normal muscle power in his lower extremities. Sensations was blunted in L5 and S1 dermatomes. MRI was  reported as L5-S1 disc prolapsed compressing left  S1 nerve root. Decompression of the L5–S1 intervertebral space was performed through a left –sidelaminotomy. Large, engorged serpentine epidural veins was found in the axilla of S1 nerve root, compressing it. Coagulative ablation of the dilated epidural vein was performed. Retrospectively, features of epidural varices were noted in the preoperative magnetic resonance imaging scans. Both patients had significant  improvement in radiculopathy immediate postoperatively, and sensory  symptoms resolved over the next 6 weeks in second case . At recent follow up, both patients had significant relief of symptoms  and  no recurrent radicular  symptoms.

Conclusion: An abnormal dilated epidural venous plexus that mimics a herniated lumbar disc is a rare entity. This pathology should be always kept in mind during lumbar disc surgery. Preoperative misdiagnosis is common. When faced with this Situation, microsurgical coagulation and decompression of the nerve root are adequate.

Keywords: Epidural varices , Disc prolapse , Radiculopathy, Decompression.


How to Cite This Article: Raghavendra V, Haridas P, Kumar A, Ajith K. Spinal Epidural Varices, a great Mimic of Intervertebral Disc Prolapse – A Case Series. Journal of Orthopaedic Case Reports 2014 Oct-Dec;4(4): 3-5. Available from:http://www.jocr.co.in/wp/2014/10/29/2250-0685-212-fulltext/

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