Conservative Treatment of Lumbar Canal Stenosis Secondary to Epidural Venous Plexus Engorgement: A Case Report
-
Mohd Alamlih
,
Isam Sami Moghamis
,
Jawad Derbas
,
Saed Owda
,
Syed Intakhab Alam
,
Saeed Ahmed Qaimkhani
Abstract
Background: Background: Epidural venous plexus (EVP) engorgement has been rarely reported as a cause of radiculopathy and back pain with different
possible underlying pathologies. Because of their rarity, these cases can be easily missed on imaging due to a lack of awareness.
Case Report: We present a case of a 58-year-old, obese woman with a history of treated breast cancer who had been experiencing lower back
pain and bilateral sciatica for one year. Clinical examination showed positive signs of neurotensin with no neurological deficit. Magnetic
resonance imaging (MRI) with contrast showed substantial engorgement of the epidural veins, causing lumbar canal stenosis at the level of
L5 and S1. Non-operative treatment with pain medications and pregabalin was successful and improved her symptoms significantly.
Conclusion: Lumbar canal stenosis secondary to epidural varicose veins is a rare cause, and it can be easily missed on imaging. An
engorged EVP should be considered in the differential diagnosis of radiculopathy in obese patients. There is an increased risk of
bleeding with surgical treatment of such a condition.
1. Berthelot JM, Laredo JD, Darrieutort-Laffite C, Maugars Y.
Stretching of roots contributes to the pathophysiology of
radiculopathies. Joint Bone Spine. 2018;85(1):41-5. doi:
10.1016/j.jbspin.2017.01.004. [PubMed: 28115269].
2. Dudeck O, Zeile M, Poellinger A, Kluhs L, Ludwig WD, Hamm B.
Epidural venous enlargements presenting with intractable
lower back pain and sciatica in a patient with absence of the
infrarenal inferior vena cava and bilateral deep venous
thrombosis. Spine (Phila Pa 1976). 2007;32(23):E688-91. doi:
10.1097/BRS.0b013e318158cf94. [PubMed: 17978646].
3. Moghamis IS, Alamlih MI, Alhardallo MA, Al Hyassat S,
Abdelsalam S, Baco A. Rare presentation of intra-spinal
extradural grade 1 chondrosarcoma: A case report. Int J Surg
Case Rep. 2022;94:106985. doi: 10.1016/j.ijscr.2022.106985.
[PubMed: 35413667]. [PubMed Central: PMC9018136].
4. Jeong HJ, Sim WS, Park HJ, Lee SH, Oh MS, Cho MK, et al. Severe
lumbar radiculopathy with epidural venous plexus
engorgement in a morbidly obese pediatric patient: A case
report. Medicine (Baltimore). 2019;98(33):e16842. doi:
10.1097/md.0000000000016842. [PubMed: 31415408]. [PubMed
Central: PMC6831412].
5. Endres S. Epidural varicosis as a possible cause of radicular
pain: a case report. J Med Case Rep. 2011;5:537. doi: 10.1186/1752-
1947-5-537. [PubMed: 22044722]. [PubMed Central: PMC3213218].
6. 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. 2002;69(2):
214-7. doi: 10.1016/s1297-319x(02)00376-7. [PubMed: 12027315].
7. LaBan MM, Wang AM. Engorgement of the cervical spinal
epidural venous plexus simulating a spinal epidural mass. Am
J Phys Med Rehabil. 2014;93(7):634-5. doi:
10.1097/PHM.0b013e31829b4d25. [PubMed: 23900011].
8. Hirabayashi Y, Shimizu R, Fukuda H, Saitoh K, Igarashi T.
Effects of the pregnant uterus on the extradural venous plexus
in the supine and lateral positions, as determined by
magnetic resonance imaging. Br J Anaesth. 1997;78(3):317-9.
doi: 10.1093/bja/78.3.317. [PubMed: 9135314].
9. LaBan MM, Wang AM, Shetty A, Sessa GR, Taylor RS. Varicosities
of the paravertebral plexus of veins associated with nocturnal
spinal pain as imaged by magnetic resonance venography: a
brief report. Am J Phys Med Rehabil. 1999;78(1):72-6. doi:
10.1097/00002060-199901000-00019. [PubMed: 9923433].
10. 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). 2004;29(21):2419-24. doi:
10.1097/01.brs.0000144354.36449.2f. [PubMed: 15507805].
11. Blattler W, Krayenbuhl C. [Spinal canal stenosis syndrome by
venous collateralization of an inferior cava thrombosis].
Phlebologie. 1993;46(3):411-4; discussion 5. [PubMed: 8248307].
Alamlih et al.: Epidural Venous Plexus Engorgement
74 J Orthop Spine Trauma. 2025; 11(2): 71-4.
https://jost.tums.ac.ir
12. Gormus N, Ustun ME, Paksoy Y, Ogun TC, Solak H. Acute
thrombosis of inferior vena cava in a pregnant woman
presenting with sciatica: a case report. Ann Vasc Surg.
2005;19(1):120-2. doi: 10.1007/s10016-004-0142-2. [PubMed:
15714380].
13. Demeulenaere A, Spelle L, Lafitte F, Brunet E, Chiras J.
[Vertebro-epidural lumbosacral vascular malformations. An
unusual cause of lumbo-sciatic pain]. J Neuroradiol.
1999;26(4):225-35. [PubMed: 10783550].
14. 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). 1994;19(18):2122-6. doi:
10.1097/00007632-199409150-00022. [PubMed: 7825056].
15. Wang L, Wang H, Sun Z, Chen Z, Sun C, Li W. Incidence and Risk
Factors for Symptomatic Spinal Epidural Hematoma Following
Posterior Thoracic Spinal Surgery in a Single Institute. Global
Spine J. 2022;12(6):1175-83. doi: 10.1177/2192568220979141.
[PubMed: 33334185]. [PubMed Central: PMC9210222].
16. Moghamis IS, El Ansari W, Abdelsalam S, Baco AM. First case of
mechanical compression by methylprednisolone crystals
following transforaminal lumbar nerve root block for left
sciatic pain leading to hyperesthesia and progressive
weakness: A case report. Int J Surg Open. 2021;34:100364. doi:
10.1016/j.ijso.2021.100364.
17. Subbiah M, Yegumuthu K. Lumbar epidural varices: An
unusual cause of lumbar claudication. Indian J Orthop.
2016;50(4):440-3. doi: 10.4103/0019-5413.185613. [PubMed:
27512228]. [PubMed Central: PMC4964779].
18. Kawai M, Udaka F, Nishioka K, Houshimaru M, Koyama T,
Kameyama M. A case of idiopathic spinal epidural lipomatosis
presented with radicular pain caused by compression with
enlarged veins surrounding nerve roots. Acta Neurol Scand.
2002;105(4):322-5. doi: 10.1034/j.1600-0404.2002.1c194.x.
[PubMed: 11939947].
19. 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).
2003;28(17):E347-50. doi: 10.1097/01.Brs.0000090500.10184.7a.
[PubMed: 12973161].
20. Gümbel U, Pia HW, Vogelsang H. [Lumbosacral vascular
anomalies as the cause of ischialgia]. Acta Neurochir (Wien).1969;20(2):131-51. doi: 10.1007/bf01401958. [PubMed: 4240895]
Stretching of roots contributes to the pathophysiology of
radiculopathies. Joint Bone Spine. 2018;85(1):41-5. doi:
10.1016/j.jbspin.2017.01.004. [PubMed: 28115269].
2. Dudeck O, Zeile M, Poellinger A, Kluhs L, Ludwig WD, Hamm B.
Epidural venous enlargements presenting with intractable
lower back pain and sciatica in a patient with absence of the
infrarenal inferior vena cava and bilateral deep venous
thrombosis. Spine (Phila Pa 1976). 2007;32(23):E688-91. doi:
10.1097/BRS.0b013e318158cf94. [PubMed: 17978646].
3. Moghamis IS, Alamlih MI, Alhardallo MA, Al Hyassat S,
Abdelsalam S, Baco A. Rare presentation of intra-spinal
extradural grade 1 chondrosarcoma: A case report. Int J Surg
Case Rep. 2022;94:106985. doi: 10.1016/j.ijscr.2022.106985.
[PubMed: 35413667]. [PubMed Central: PMC9018136].
4. Jeong HJ, Sim WS, Park HJ, Lee SH, Oh MS, Cho MK, et al. Severe
lumbar radiculopathy with epidural venous plexus
engorgement in a morbidly obese pediatric patient: A case
report. Medicine (Baltimore). 2019;98(33):e16842. doi:
10.1097/md.0000000000016842. [PubMed: 31415408]. [PubMed
Central: PMC6831412].
5. Endres S. Epidural varicosis as a possible cause of radicular
pain: a case report. J Med Case Rep. 2011;5:537. doi: 10.1186/1752-
1947-5-537. [PubMed: 22044722]. [PubMed Central: PMC3213218].
6. 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. 2002;69(2):
214-7. doi: 10.1016/s1297-319x(02)00376-7. [PubMed: 12027315].
7. LaBan MM, Wang AM. Engorgement of the cervical spinal
epidural venous plexus simulating a spinal epidural mass. Am
J Phys Med Rehabil. 2014;93(7):634-5. doi:
10.1097/PHM.0b013e31829b4d25. [PubMed: 23900011].
8. Hirabayashi Y, Shimizu R, Fukuda H, Saitoh K, Igarashi T.
Effects of the pregnant uterus on the extradural venous plexus
in the supine and lateral positions, as determined by
magnetic resonance imaging. Br J Anaesth. 1997;78(3):317-9.
doi: 10.1093/bja/78.3.317. [PubMed: 9135314].
9. LaBan MM, Wang AM, Shetty A, Sessa GR, Taylor RS. Varicosities
of the paravertebral plexus of veins associated with nocturnal
spinal pain as imaged by magnetic resonance venography: a
brief report. Am J Phys Med Rehabil. 1999;78(1):72-6. doi:
10.1097/00002060-199901000-00019. [PubMed: 9923433].
10. 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). 2004;29(21):2419-24. doi:
10.1097/01.brs.0000144354.36449.2f. [PubMed: 15507805].
11. Blattler W, Krayenbuhl C. [Spinal canal stenosis syndrome by
venous collateralization of an inferior cava thrombosis].
Phlebologie. 1993;46(3):411-4; discussion 5. [PubMed: 8248307].
Alamlih et al.: Epidural Venous Plexus Engorgement
74 J Orthop Spine Trauma. 2025; 11(2): 71-4.
https://jost.tums.ac.ir
12. Gormus N, Ustun ME, Paksoy Y, Ogun TC, Solak H. Acute
thrombosis of inferior vena cava in a pregnant woman
presenting with sciatica: a case report. Ann Vasc Surg.
2005;19(1):120-2. doi: 10.1007/s10016-004-0142-2. [PubMed:
15714380].
13. Demeulenaere A, Spelle L, Lafitte F, Brunet E, Chiras J.
[Vertebro-epidural lumbosacral vascular malformations. An
unusual cause of lumbo-sciatic pain]. J Neuroradiol.
1999;26(4):225-35. [PubMed: 10783550].
14. 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). 1994;19(18):2122-6. doi:
10.1097/00007632-199409150-00022. [PubMed: 7825056].
15. Wang L, Wang H, Sun Z, Chen Z, Sun C, Li W. Incidence and Risk
Factors for Symptomatic Spinal Epidural Hematoma Following
Posterior Thoracic Spinal Surgery in a Single Institute. Global
Spine J. 2022;12(6):1175-83. doi: 10.1177/2192568220979141.
[PubMed: 33334185]. [PubMed Central: PMC9210222].
16. Moghamis IS, El Ansari W, Abdelsalam S, Baco AM. First case of
mechanical compression by methylprednisolone crystals
following transforaminal lumbar nerve root block for left
sciatic pain leading to hyperesthesia and progressive
weakness: A case report. Int J Surg Open. 2021;34:100364. doi:
10.1016/j.ijso.2021.100364.
17. Subbiah M, Yegumuthu K. Lumbar epidural varices: An
unusual cause of lumbar claudication. Indian J Orthop.
2016;50(4):440-3. doi: 10.4103/0019-5413.185613. [PubMed:
27512228]. [PubMed Central: PMC4964779].
18. Kawai M, Udaka F, Nishioka K, Houshimaru M, Koyama T,
Kameyama M. A case of idiopathic spinal epidural lipomatosis
presented with radicular pain caused by compression with
enlarged veins surrounding nerve roots. Acta Neurol Scand.
2002;105(4):322-5. doi: 10.1034/j.1600-0404.2002.1c194.x.
[PubMed: 11939947].
19. 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).
2003;28(17):E347-50. doi: 10.1097/01.Brs.0000090500.10184.7a.
[PubMed: 12973161].
20. Gümbel U, Pia HW, Vogelsang H. [Lumbosacral vascular
anomalies as the cause of ischialgia]. Acta Neurochir (Wien).1969;20(2):131-51. doi: 10.1007/bf01401958. [PubMed: 4240895]
| Files | ||
| Issue | Vol 11 No 2 (2025) | |
| Section | Case Report | |
| Keywords | ||
| #Epidural Injections #Lumbar Region #Pain #Spinal Canal #Spinal Injections #Stenosis | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Alamlih M, Moghamis I, Derbas J, Owda S, Alam S, Qaimkhani S. Conservative Treatment of Lumbar Canal Stenosis Secondary to Epidural Venous Plexus Engorgement: A Case Report. J Orthop Spine Trauma. 2025;11(2):73-6.
