Vascular loops mimicking herniated lumbar discs: fair warning

Abstract Objective: 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. Methods 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 time 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 anarterio-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. Conclusions Either epidural varix or arterio-venous fistula in the lumbar area may mimic a herniated disc on imaging studies. With the usual approach they can be operated safely. Resection of the anomaly can be sufficient for alleviating radiculopathy symptoms.