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

doi:10.18502/jost.v11i2.18886

Mohd Alamlih Specialist, Department of Orthopedic Surgery, Hamad Medical Corporation, Doha, Qatar
Isam Sami Moghamis Specialist, Department of Orthopedic Surgery, Hamad Medical Corporation, Doha, Qatar
Jawad Derbas Resident, Department of Orthopedics Surgery, Hamad Medical Corporation, Doha, Qatar
Saed Owda Resident, Department of Orthopedics Surgery, Hamad Medical Corporation, Doha, Qatar
Syed Intakhab Alam Consultant, Department of Radiology, Hamad Medical Corporation, Doha, Qatar
Saeed Ahmed Qaimkhani Senior Consultant, Department of Orthopedic Surgery, Hamad Medical Corporation, Doha, Qatar

DOI: https://doi.org/10.18502/jost.v11i2.18886

Keywords: Epidural Injections; Lumbar Region; Pain; Spinal Canal; Spinal Injections; Stenosis

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.