School of Medicine, Regional Service of Neurosurgery, "Virgen de La Arrixaca" University Hospital, Universidad de Murcia, El Palmar, 30120, Murcia, Spain.
Neurosurgery Unit, Hospital Quiron Torrevieja, Torrevieja, Spain.
Neurosurg Rev. 2024 Aug 15;47(1):435. doi: 10.1007/s10143-024-02669-6.
The authors report their experience with twenty-one consecutive patients who presented with symptoms and imaging characteristics of a herniated lumbar disc; of whom, at the time of surgery had a vascular loop instead. The procedure was performed on 14 women and seven men with a mean age of 39 years. Clinical complaints included lumbar aching with one limb overt radiculopathy in all patients; with additional sphincter dysfunction in two cases. Symptoms had developed within a mean period of three months. In all patients, the disc was exposed through an L5-S1 (n = 10); L4-L5 (n = 5) and L3-L4 (n = 6) open minimal laminotomy. In 16 patients, rather than a herniated disc they had a lumbar epidural varix, while an arterio-venous fistula was found in the remaining five cases. In all cases, the vascular disorder was resected and its subjacent disc was left intact. One patient had a postoperative blood transfusion. While the radiculopathy dysfunction improved in all patients, four patients reported lasting lumbar pain following surgery. The postoperative imaging confirmed the resolution of the vascular anomaly and an intact disc. The mean length of the follow-up period was 47 months. Either epidural varix or arterio-venous fistula in the lumbar area may mimic a herniated disc on imaging studies. With the usual technique they can be operated safely. Resection of the anomaly can be sufficient for alleviating radiculopathy symptoms.
作者报告了他们在 21 例连续患者中的经验,这些患者具有突出的腰椎间盘的症状和影像学特征;其中,在手术时发现是血管环。该手术在 14 名女性和 7 名男性中进行,平均年龄为 39 岁。临床症状包括腰痛,所有患者均有单肢神经根病变;其中 2 例有括约肌功能障碍。症状在平均 3 个月内出现。所有患者均通过 L5-S1(n=10)、L4-L5(n=5)和 L3-L4(n=6)开放性最小椎板切开术暴露椎间盘。在 16 例患者中,他们的椎间盘突出物是硬膜外静脉曲张,而在其余 5 例患者中则发现动静脉瘘。在所有病例中,均切除了血管病变,并保留了其下方的椎间盘。有 1 例患者术后输血。虽然所有患者的神经根病变功能均得到改善,但 4 例患者术后仍有腰痛。术后影像学检查证实血管异常已消除,椎间盘完整。平均随访时间为 47 个月。在腰椎区域,硬膜外静脉曲张或动静脉瘘可能在影像学研究中模拟椎间盘突出。使用常规技术可以安全地进行手术。切除异常可以缓解神经根病变症状。