Spine Surgery Complicated by an Engorged Lumbar Epidural Venous Plexus from Cerebral Spinal Fluid Over-shunting: A Case Report and Review of the Literature.
World Neurosurg. 2017 Dec 14;:
Authors: Fredrickson VL, Patel A, Pham MH, Strickland BA, Ohiorhenuan I, Chen T
BACKGROUND: Over-shunting of cerebral spinal fluid may lead to intracranial hypotension and dilation of spinal epidural veins. Radiculopathy may rarely occur secondary to these engorged spinal epidural veins. In addition, the etiology of the radiculopathy may be obscured by concomitant spinal degenerative changes.
CASE DESCRIPTION: We present a case of a 29-year-old female with positional headaches from intracranial hypotension in the setting of cerebral spinal fluid over-shunting. The patient also had back pain and lumbar radiculopathy which became more severe following lumboperitoneal shunt placement. On radiographic workup, there was evidence of right L5 nerve root impingement secondary to a disc bulge, as well as an engorged lumbar epidural venous plexus due to over-shunting. The patient underwent surgery for a planned L4-5 decompression with a transforaminal lumbar interbody fusion. The operation was complicated by rapid blood loss originating from the epidural venous plexus, therefore we were unable to safely place the interbody graft. Herein, we review the case, the pathogenesis, and the current clinical literature.
CONCLUSION: Spinal surgeons need to be aware of the rare diagnosis of radiculopathy secondary to epidural venous plexus engorgement, as it may change the treatment approach or lead to deleterious intraoperative consequences, such as hemorrhage.
PMID: 29248773 [PubMed – as supplied by publisher]