Surgical treatment of lumbar epidural varices

Abstract

Object An epidural varix of the lumbar spine is an acquired pathological entity that results from dilation of the internal vertebral venous plexus. The dilated veins in the epidural spaces or in the intervertebral foramen cause irritation or compression of the thecal sac and nerve roots, and this in turn causes lumbar radiculopathy. The lesions develop as an independent process or are accompanied by degenerative changes of the lumbar spine. Resection of varicose veins can be complicated when significant venous bleeding occurs. The purpose of the present study was to develop diagnostic criteria for lumbar epidural varices and methods of surgical treatment and to analyze the results of treatment. Methods There were 43 surgically treated patients in whom lumbar radiculopathy was caused by epidural varices. The mean duration of symptoms was 11 months (range 5–49 months) and the mean age of the patients was 41 years (range 26–68 years). Segmentary varices were found in 14 patients, local varices in 21, and extensive varices in eight. Patients underwent preoperative magnetic resonance imaging and vertebral venography. Of 43 cases, the varicose veins were completely occluded in all 14 patients with segmentary varices of the segmentary-type lesion. Of 21 patients with local varices, total occlusion was obtained in 17 patients and partial occlusion in four. In the patients with extensive varices, total occlusion was not performed; instead, partial occlusion was undertaken. Resolution of lumbar radicular syndromes was observed, to some extent, in all patients. Radicular pain regressed in 12 of 14 patients with segmentary varices, in 18 of 19 patients with local varices, and in three of four patients with extensive varices. Nerve root–related sensory disturbances regressed in six of 10 patients with segmentary varices, in 11 of 15 patients with local varices, and in one patient with extensive varices. Motor deficits regressed in three of eight patients with segmentary varices, in three of six patients with local varices, and in none among those with extensive varices. Conclusions Epidural varicosity is a specific form of spinal disease. Its diagnostic clarification and surgical treatment are difficult and have only recently been developed. Precise diagnosis and a well-planned surgery allow for a positive outcome.