spontaneous Regression of symptomatic Lumbar Epidural Varix : A Case report

Abstract

A lumbar epidural varicose vein is a rare clinical condition that can lead to neurological deficits. 3 types of lumbar epidural varicose veins were described according to the magnetic resonance imaging (MRI) findings: Type 1 is a thrombosed dilated epidural vein, type 2 is a non-thrombosed dilated epidural vein and type 3 is a sub-membraneous epidural hematoma. Enlarged epidural venous plexuses must be decompressed if they have lead to a neurological deficit. Surgical treatment is by excision or disrupting the cyst's integrity. We present a case of lumbar epidural varicose vein that was surgically treated twice and showed no radiological change despite the disruption of integrity with a partial excision. The lesion spontaneously and completely disappeared in the late period. We emphasize the importance of MRI in follow-up.

Case Details

Disease Location

Spine (ventral right epidural space, extending from l2-l3 intervertebral disc inferiorly along l3 body to the l3-l4 disc space)

Personal Characteristics

57 -year-old female no history of traumatic injury or spinal injection

Clinical Characteristics

Lumbar epidural varix first experienced a sudden episode of low back pain radiating to the right lower extremity during exercise. 4 weeks later this pain was accompanied by right lower extremity paresthesia leading to being admitted motor exam revealed weakness of the musculature in the right quadriceps femoris and tibialis anterior muscle (grade 4/5), sensation was intact, the right patellar reflex was depressed. The straight leg-raising test was positive at 70 degrees on the right side. MRI showed a disc herniation at l2-l3 and a mass lesion in the ventral right epidural space that extended from the l2-l3 intervertebral disc space inferiorly along the posterior aspect of the l3 vertebral body to the l3-l4 intervertebral disc space the mass differed from l2-l3 degenerative disc in signal intensity, the lesion was isointense on t1 and hyperintense on t2. Sagittal MRI, the intraspinal mass lesion appeared to communicate with the herniated disc--discography revealed no connection between the herniated disc and intraspinal mass lesion at either l2-l3 or l3-l4 suggesting the mass was not a discal cyst

Remission Characteristics

Symptoms and signs related to radiculopathy gradually decreased and she was able to walk unassisted 1 week after admission, follow-up MRI showed a size reduction of the epidural mass which extended from the epidural venous plexus consistent with epidural varix within 2 weeks after admission, low back and right lower extremity pain disappeared. The straight leg-raising test became negative and muscle weakness and right lower extremity paresthesia improved. Repeat MRI every 2 weeks revealed gradual decrease in size of the mass

Treatment & Mechanisms

Proposed Remission Mechanisms

"disappearing discs" recovery of insufficient epidural venous return due to improvement of a lesion causing obstruction

Clinical Treatment

None reported

Non-Clinical Treatment

Lumbosacral corset and bed rest