Introduction: Lumbar epidural varices may mimic lumbar disc herniation by causing radiculopathy. In various publications, the incidence rate of lumbar epidural varices was reported as 0.067%-1.2% . The diagnosis of this entity is usually made intraoperative. In this presentation, we report a patient of lumbar epidural varix presented with radiculopathy symptoms and mimicked a lumbar disc herniation.
Methods: Case Report: A 26-years-old male patient presented with low back and severe right leg pain. He was healthy otherwise. Lasègue's sign was positive and loss of sensation in L5 dermatome was noted. There was no motor deficit. Sacrolumbar MRI showed a lesion in the epidural space at upper L5 level just posterior to L5 vertebra on the right appearing as hypointense on the T1-weighted images and hyperintense on the T2-weighted images (Figure 1-2).The patient underwent surgery and right L4-5 hemilaminectomy was performed. A well shaped, brown mass lesion, which compressed the right L5 nerve root was identified during surgery. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient’s complaints disappeared in the postoperative period. After surgery, the varix wasn’t observed on the postoperative MRI scan(Figure 3).
Results: Discussion: Mechanism of the lumbar varix is exactly unknown, but increased venous pressure due to the blockage of blood flowing through to vena cava system is thought as the main reason. Locally factors such as herniated disc also play a role in the etiology of venous varix by causing compression. In many reports, lumbar varices have been found in association with spinal stenosis, spondyloarthropathy and ankylosing spondylitis. Though thrombosed varices are often saw hyperintense on T1-weighted and T2-weighted images, they can be saw hypointensity on T2-weighted MRI sequences according to intensity of the thrombosis. Surgery is the best treatment for the symptomatic spinal epidural varices. The gaols of the surgery should be the decompression of the dural sac and/or spinal nerve roots, and elimination of dilated veins’ irritation.
Conclusions: Symptomatic epidural varices are rare entities and clinically and radiologically mimic lumbar disc herniation. Spinal epidural varices should be kept in mind in the differential diagnosis of the lumbar disc herniation.
Patient Care: A precise diagnostic workup and well-planned surgery will lead to a successful outcome
Learning Objectives: Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically and therefore must be kept in mind in the differential diagnosis of lumbar disc herniations