Epidural varicosis as a possible cause of radicular pain: a case report.
Epidural varicosis as a possible cause of radicular pain: a case report.
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DOI：
10.1186/1752-1947-5-537
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发表时间：
2011-11-01
影响因子：
1
通讯作者：
Endres S
中科院分区：
文献类型：
--
作者：
Endres S
自从计算机断层扫描和磁共振成像的引入，硬膜外静脉曲张的发病率下降了0.07%至1.2%。尽管使用这些现代影像学方法，但仍然难以将硬膜外静脉曲张的诊断与其他原因（如髓核脱垂）区分开来。我们提出的情况下，48岁的白人妇女谁经历了坐骨神经痛七年。体格检查显示右侧L5神经根疼痛，神经张力阳性体征。在子宫内膜异位症的选择性子宫切除术中，她的小骨盆出现了以前未发现的异常明显的静脉曲张。术后，我们的患者出现了症状性肺栓塞。她的腰椎磁共振断层扫描的结果，结合我们病人的病史，被放射科医生认为是硬膜外静脉曲张的迹象。没有进一步的病理异常，可能是神经根疼痛的原因被发现。在硬膜外静脉曲张与刺激的神经结构，由于下腔静脉发育不全的情况下，手术治疗导致不满意的结果。通过解决腔静脉病变的原因可以获得明显更好的结果。在下腔静脉发育不全或发育不全的情况下，这并不总是可能的;因此，在我们的患者中，只能进行对症治疗结合抗凝剂和加压治疗。
The incidence rate of epidural varicosis has declined by 0.07% to 1.2% since the introduction of computed tomography and magnetic resonance imaging. Despite the use of these modern imaging methods it can still be difficult to distinguish the diagnosis of epidural varicosis from other causes, such as nucleus pulposus prolapse. We present the case of a 48-year-old Caucasian woman who had been experiencing sciatic pain for seven years. A physical examination showed nerve root pain at L5 on the right side, with positive signs of neurotension. During an elective hysterectomy due to endometriosis, unusually pronounced varicosis in her lesser pelvis was seen that had not previously been detected. Postoperatively, our patient developed a symptomatic pulmonary embolism. Findings from magnetic resonance tomography of her lumbar spine, in conjunction with our patient's history, were considered by the radiologist to be indicative of epidural varicosis. No further pathological abnormalities that could have been the cause of the nerve root pain were found. In cases of epidural varicosis with irritation of neural structures as a result of inferior vena cava hypoplasia, surgical treatment leads to unsatisfactory results. Significantly better results can be achieved by resolving the cause of the vena cava pathology. In cases of hypoplasia or aplasia of the inferior vena cava this is not always possible; consequently, as in the case of our patient, only a symptomatic therapy in combination with an anticoagulant and compression therapy can be performed.