Epidural Venous Plexus Engorgement as a Potential Cause of Lumbar Radicular Pain: a systematic review

Ingurgitamento do Plexo Venoso Epidural como Possível Causa de Dor Radicular Lombar: uma revisão sistemática

• Luis Gustavo Biondi Soares    
• Emilly Beatriz Aleixo Almeida    
• Raívson Diogo Félix Fernandes    
• Marina Maia Vieira Wanderley Pimentel    
• Victor Vieira Soares    
• Mateus Wendler Ferreira Lopes    
• José Alencar de Sousa Segundo    
• Edgar Daniel Guzmán-Ríos    
• Felipe Salvagni Pereira    
• Leandro Assis Barbosa    

• https://doi.org/10.22290/jbnc.2026.02031004
• J Bras Neurocirur 37 (2):199-217, 2026

Resumo

O ingurgitamento do plexo venoso epidural (PVE) é uma causa rara, porém clinicamente significativa, de radiculopatia lombar, frequentemente subdiagnosticada devido à sua semelhança com condições espinhais mais comuns, como hérnia de disco e estenose espinhal. Esta revisão sistemática incluiu 23 estudos, totalizando 83 pacientes, para avaliar a associação entre o ingurgitamento do PVE e sintomas radiculares. As manifestações clínicas mais frequentes foram dor lombar (83,1%) e radiculopatia (56,6%). Anomalias da veia cava inferior (VCI) foram relatadas em 32,9% dos casos. A ressonância magnética foi o principal método diagnóstico, geralmente demonstrando veias epidurais dilatadas com compressão neural. As intervenções terapêuticas variaram desde anticoagulação sistêmica até procedimentos cirúrgicos e endovasculares. Esses achados destacam a importância de considerar o ingurgitamento do PVE no diagnóstico diferencial de dor radicular refratária, a fim de evitar intervenções invasivas desnecessárias.

Palavras-chave

Malformações vasculares; Sistema nervoso central; Dor lombar; Distúrbios vasculares; Medula espinhal; Coluna

Abstract

Epidural venous plexus (EVP) engorgement is a rare yet clinically significant cause of lumbar radiculopathy, often underdiagnosed due to its resemblance to more common spinal conditions such as disc herniation and spinal stenosis. This systematic review included 23 studies comprising 83 patients to evaluate the association between EVP engorgement and radicular symptoms. The most frequent clinical manifestations were low back pain (83.1%) and radiculopathy (56.6%). Inferior vena cava (IVC) anomalies were reported in 32.9% of cases. Magnetic resonance imaging was the primary diagnostic modality, typically demonstrating dilated epidural veins with neural compression. Therapeutic interventions ranged from systemic anticoagulation to surgical and endovascular procedures. These findings underscore the importance of considering EVP engorgement in the differential diagnosis of refractory radicular pain to prevent unnecessary invasive interventions.

Keywords

Vascular malformations; Central nervous system; Low back pain; Vascular diseases; Spinal cord; Spine

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1Department of Neurosurgery, Santa Casa de Montes Claros, Montes Claros, MG, Brazil.

2Faculdade Ciências Médicas, Centro Universitário Unifacisa, Campina Grande, PB, Brazil.

3Department of Neurosurgery, Universidade de São Paulo – USP, Ribeirão Preto, SP, Brazil.

4Department of Medicine, Family Justice Center, Tepic, Nayarit, México.

 

5Department of Neurosurgery, Faculdade Evangélica Mackenzie do Paraná, Curitiba, PR, Brazil.

6Department of Neurosurgery, Hospital Estadual Central de Vitória, Vitória, ES, Brazil.