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: 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.
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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 Engorgement74 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]
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 Engorgement74 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 | |
| DOI | https://doi.org/10.18502/jost.v11i2.18886 | |
| Keywords | ||
| Epidural Injections Lumbar Region Pain Spinal Canal Spinal Injections Stenosis | ||
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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.
