Epidural Varicose Vein Mimic Disc Prolapse and Causing a Severe Radicular pain: A Case Report View PDF

^*Ammar Najim Abood
Department Of Surgery, College Of Medicine, Diyala University, Iraq

^*Corresponding Author:

Ammar Najim Abood
Department Of Surgery, College Of Medicine, Diyala University, Iraq
Email:ortho_a@yahoo.com

Published on: 2020-03-07

Abstract

Venous varicose of epidural is considered a rare cause of nerve root and thecal sac compression and impingement that leads to lower limb radiculopathy. The purpose of this study is to draw attention to this problem during operation. It also aims to focus shed a light on using magnetic resonance imaging (MRI) before the operation. This research also attempts to evaluate the outcome of the surgery.
Symptoms of epidural varicose with radiculopathy are rare and the diagnosis is often inaccurate by preoperative clinical examination and radiology investigations. Thus, in many cases, the diagnosis is made intraoperative.
The case was a 40 years old female who consulted our outpatient clinic complaining from acute radicular pain in the lower back and down of her right lower limb. MRI was done for her and showed paracentral disc herniation. Intraoperatively, abnormal dilatation of epidural vein impingement on L4 nerve root with no foraminal Stenos is as seen. We initiated a thermocoagulation of the epidural vein from proximal to distal ends at the disc level and used a gel foam patch to control bleeding that was removed all at the end of the operation. Then, coagulation ablation was performed. The operation resulted in relief of symptoms and neurologic recovery occurred during the follow-up period. According to our case and previously published case reports, the outcome is good with the recovery of neurological signs and symptoms that can be obtained by coagulation ablation of epidural varicose vein.

Keywords

Lumber Epidural Varicose Vein;MRI; Minimal Invasive Surgery; Radicular Pain

Introduction

Common symptoms of disc herniation or spinal stenosis are back pain and radiculopathy. The symptoms also include those related to ischemic injury of the neural structure, compression, and inflammatory changes [1]. Previous studies show that varicose of epidural vein rarely causes radicular pain [2-4]. Some studies show that lumber (L) epidural varicose vein happens in 0.67% - 1.2% [5].
Our case is a lumber epidural varicose vein at L3-L4 level with severe pain and mild weakness in the right leg. A microscopic laminotomy, flavectomy and nerve root retraction were done and we demonstrated 1 cm diameter dilated varicose vein.