Physical Medicine and Rehabilitation, Walter Reed Army Medical Center, Washington, DC 20307, USA.
Spine (Phila Pa 1976). 2010 Aug 15;35(18):E921-4. doi: 10.1097/brs.0b013e3181e83d6e.
Case report and clinical discussion.
To describe a unique etiology for a patient presenting with exercise-induced lower extremity numbness found to have agenesis of the infrarenal inferior vena cava (IVC) and a large vein draining the confluence of the iliac veins through the L4 foramen into the epidural plexus.
Epidural venous abnormalities are infrequently determined to be the etiology of nerve root compression syndromes. Such cases have been described in patients with absent IVC with thrombosis. We are unaware of any previously described cases of absent IVC with a primary route of venous return through the epidural venous plexus, resulting in symptoms in the absence of thrombosis.
We describe a case of a 34-year-old man who presented complaining of numbness of legs as well as cauda equina symptoms occurring during exercise. He was found to have infrarenal absence of the IVC with the confluence of the iliac veins forming a large draining vein which entered the L4 foramen into the epidural venous plexus. Pre- and postexercise magnetic resonance imaging scans were performed to compare change in the size of the plexus.
Postexercise magnetic resonance imaging showed notable increase in the volume of the epidural venous plexus of the lower lumbar spine. The patient was referred to neurosurgery and vascular surgery, which did not intervene. On follow-up 2 years later, the patient developed significant right deep venous thrombosis and was found to be heterozygous for factor V Leiden mutation.
This case demonstrates the breadth of anatomic and physiologic understanding a clinician must draw on when approaching patients with nerve root compression symptoms. It is also pertinent to consider performing a hypercoagulable work-up in patients with vascular deformations, as this may prevent future thrombosis.
病例报告及临床讨论。
描述一位因运动引起的下肢麻木而就诊的患者的独特病因，该患者存在肾下下腔静脉（IVC）缺失，且一条大静脉从髂静脉汇合处穿过 L4 孔进入硬膜外丛，将其引流。
硬膜外静脉异常很少被确定为神经根压迫综合征的病因。在没有 IVC 且存在血栓的患者中已经描述过这种情况。我们不知道以前有任何描述过的没有 IVC 且静脉回流的主要途径通过硬膜外静脉丛导致在没有血栓的情况下出现症状的病例。
我们描述了一位 34 岁男性的病例，他主诉在运动时腿部麻木和马尾神经症状。发现他存在肾下 IVC 缺失，髂静脉汇合处形成一条大引流静脉，穿过 L4 孔进入硬膜外静脉丛。进行了运动前后的磁共振成像扫描以比较静脉丛大小的变化。
运动后磁共振成像显示下腰椎硬膜外静脉丛的体积明显增加。患者被转诊至神经外科和血管外科，但未进行干预。2 年后随访时，患者出现明显的右侧深静脉血栓形成，且存在因子 V 莱顿突变杂合子。
该病例表明，临床医生在处理神经根压迫症状的患者时，必须综合运用广泛的解剖学和生理学知识。对于存在血管畸形的患者，进行高凝状态检查也很重要，因为这可能预防未来的血栓形成。
