Patterns of Epidural Venous Varicosity in Lumbar Stenosis

Abstract

ObjectiveEpidural venous varicosity (congestion of the epidural vein) is rarely introduced as an influential factor of clinical symptoms. However, there are several studies suggesting that epidural venous varicosity results in neurologic symptoms. We would like to highlight evidence that epidural venous varicosity results in neurologic symptoms and the relation between epidural venous varicosity and neural structure observed during the surgery. Based on our experiences, we also propose a new classification of epidural venous varicosity.Methods29 patients with symptomatic lumbar stenosis received microsurgical decompression via partial hemilaminectomy. The authors retrospectively reviewed all recorded intraoperative pictures and categorized patterns of venous varicosities with relationship to neural structures.ResultsType A is conditions in which epidural veins are dilated but located parallel to the nerve root on the lateral side of the nerve root and thus do not compress the nerve root. Type B is conditions in which varices are located on the anterior lateral side of the nerve root to compress the nerve root. Type C is conditions in which varices are encircled around the nerve root and compressing the nerve root.ConclusionEpidural venous varicosity is observed in most lumbar stenosis patients with clinical symptoms. Of the types, the types of epidural venous varicosity compressing nerve structures were Type B and Type C. All epidural venous varicosities were removed regardless of classification during operations. Most patients showed relief in clinical symptoms after the operation. We thought to epidural venous varicosity as a factor that causes clinical symptoms of lumbar stenosis.

Tranexamic acid reduces perioperative blood loss of posterior lumbar surgery for stenosis or spondylolisthesis

“…[3,5,8,19] The increased fibrinolytic activity and spinal venous plexus injury are critical factors contributing toward the perioperative blood loss. [8,19,24] TA can competitively inhibit plasmin and plasminogen, thereby impeding the fibrinolysis and stabilizing the blood clot. [19] Previous studies demonstrated that TA could inhibit the fibrinolytic activity and decrease blood loss in spinal deformity surgery or long segment fixation and fusion surgery.…”

“…The surgery for lumbar stenosis and spondylolisthesis is not identical to the deformity correction surgery or simple long segment fixation and fusion surgery. The vertebral venous plexus is common in patients with lumbar stenosis or spondylolisthesis, [24,26] when injured during the operation, renders hemostasis difficult. [4,14,27] TA can supposedly stabilize the blood clot to block the epidural venous plexus vascular rupture, thus, reducing the bleeding.…”

Spinal Epidural varicosity resembling prolapsed intervertebral disc on MRI: A diagnostic dilemma for lumbar canal stenosis

“…Radiologically may resemble herniated disc, such diagnostic dilemma of canal stenosis on radiology may be surprising intraoperatively sometimes like in our case. [4][5][6][7][8][9] Every neurosurgeon should be careful regarding this issue that all radiculopathy or neurogenic claudication are not due to herniated disc which resembles like disc on MRI.…”

“…& neurogenic claudication. [1][2][3][4] Epidural venous plexus enlargement, presenting with low back pain and radiculopathy, is an uncommon cause of nerve roots impingement. This condition commonly mimics a herniated nucleus pulposus radiologically.…”

A role for spinal cord hypoxia in neurodegeneration

“…While early diagnosis for early relief of the compression would probably be the best option, for example with surgery 41 , diagnosis tends to happen after neurological symptoms have already appeared, which is by definition too late. This applies both to arterial and venous compression; while most research is focussed on the former, there is also related compression of the venous plexus at the cauda equina, which could be correlated with neurodegeneration, particularly with lumbar stenosis 42–44 .…”