Fredrickson Vance L, Patel Arati, Pham Martin H, Strickland Ben A, Ohiorhenuan Ifije, Chen Thomas
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
World Neurosurg. 2018 Mar;111:68-72. doi: 10.1016/j.wneu.2017.12.027. Epub 2017 Dec 14.
Overshunting of cerebrospinal fluid may lead to intracranial hypotension and dilation of spinal epidural veins. Radiculopathy may rarely occur secondary to engorged spinal epidural veins. In addition, the cause of radiculopathy may be obscured by concomitant spinal degenerative changes. We present a case and review the pathogenesis as well as the current clinical literature.
A 29-year-old woman presented with positional headaches from intracranial hypotension in the setting of cerebrospinal fluid overshunting. The patient also had back pain and lumbar radiculopathy, which became more severe after lumboperitoneal shunt placement. On radiographic work-up, there was evidence of right L5 nerve root impingement secondary to a disc bulge and an engorged lumbar epidural venous plexus secondary to overshunting. 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, and we were unable to safely place the interbody graft.
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.
过度引流脑脊液可能导致颅内低压和脊髓硬膜外静脉扩张。神经根病很少继发于脊髓硬膜外静脉充血。此外，神经根病的病因可能被同时存在的脊柱退行性变所掩盖。我们报告一例病例并回顾其发病机制以及当前的临床文献。
一名29岁女性因脑脊液过度引流导致颅内低压出现体位性头痛。患者还伴有背痛和腰神经根病，在腰腹分流术后加重。影像学检查显示，存在继发于椎间盘突出的右侧L5神经根受压以及继发于过度引流的腰段硬膜外静脉丛充血。患者接受了计划中的L4 - 5减压及经椎间孔腰椎椎体间融合手术。手术因硬膜外静脉丛快速失血而复杂化，我们无法安全置入椎间融合器。
脊柱外科医生需要意识到硬膜外静脉丛充血继发神经根病这一罕见诊断，因为它可能改变治疗方法或导致术中出现如出血等有害后果。
