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Sciatic nerve compression by a gluteal vein varicosity
The Spine Journal
Sciatic nerve compression by a gluteal vein varicosity A 36-year-old woman complained of mild low back pain and left sciatica at the first trimester of pregnancy, which worsened after delivery. A lumbar magnetic resonance imaging showed a L5–S1 disc degeneration. Low back pain resolved after two epidural steroid injections, but she developed a refractory sciatica worsened by supine and sitting positions. Physically, the patient had pain and contracture over the left piriformis muscle. Straight Leg Raising test was negative. No neurologic deficits were detectable. A pelvic and hip magnetic resonance imaging scan revealed the presence of a varicosity of the left gluteal vein, which contacts and compresses the sciatic nerve just behind the left hip (Figure). The patient refused surgery and was managed by diet finalized to weight loss, physical therapy, and centrally acting muscle relaxants (pridinol mesylate) with complete resolution of the symptoms in 1 month. The presence of an atypical sciatica in the absence of low back pain is a clinical challenge and should rise the suspect of an extraspinal disease such as gluteal varicosity [1–3].
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(2014)
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References [1] Hu MH, Wu KW, Jian YM, et al. Vascular compression syndrome of sciatic nerve caused by gluteal varicosities. Ann Vasc Surg 2010;24: 1134.e1–4. [2] Bendszus M, Rieckmann P, Perez J, et al. Painful vascular compression syndrome of the sciatic nerve caused by gluteal varicosities. Neurology 2003;61:985–7. [3] Papapietro N, Gulino G, Zobel BB, et al. Cyclic sciatica related to an extrapelvic endometriosis of the sciatic nerve: new concepts in surgical therapy. J Spinal Disord Tech 2002;15:436–9.
Alberto Di Martino, MD, PhD Nicola Papapietro, MD Vincenzo Denaro, MD Department of Orthopaedics and Trauma Surgery University Campus Bio-Medico of Rome Via Alvaro del Portillo, 200 Rome 00128, Italy FDA device/drug status: Not applicable. Author disclosures: ADM: Nothing to disclose. NP: Nothing to disclose. VD: Nothing to disclose.
Figure. Sciatic nerve compression by a gluteal vein varicosity. Coronal (Left) MRI showing the varicosity of the left gluteal vein (arrows); the axial images (Right) show the contact of the sciatic nerve (arrow) with the varicose vein, just behind the left hip. MRI, magnetic resonance imaging. 1529-9430/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2014.03.008
Sciatic nerve compression by a gluteal vein varicosity A 36-year-old woman complained of mild low back pain and left sciatica at the first trimester of pregnancy, which worsened after delivery. A lumbar magnetic resonance imaging showed a L5–S1 disc degeneration. Low back pain resolved after two epidural steroid injections, but she developed a refractory sciatica worsened by supine and sitting positions. Physically, the patient had pain and contracture over the left piriformis muscle. Straight Leg Raising test was negative. No neurologic deficits were detectable. A pelvic and hip magnetic resonance imaging scan revealed the presence of a varicosity of the left gluteal vein, which contacts and compresses the sciatic nerve just behind the left hip (Figure). The patient refused surgery and was managed by diet finalized to weight loss, physical therapy, and centrally acting muscle relaxants (pridinol mesylate) with complete resolution of the symptoms in 1 month. The presence of an atypical sciatica in the absence of low back pain is a clinical challenge and should rise the suspect of an extraspinal disease such as gluteal varicosity [1–3].
-
(2014)
-
References [1] Hu MH, Wu KW, Jian YM, et al. Vascular compression syndrome of sciatic nerve caused by gluteal varicosities. Ann Vasc Surg 2010;24: 1134.e1–4. [2] Bendszus M, Rieckmann P, Perez J, et al. Painful vascular compression syndrome of the sciatic nerve caused by gluteal varicosities. Neurology 2003;61:985–7. [3] Papapietro N, Gulino G, Zobel BB, et al. Cyclic sciatica related to an extrapelvic endometriosis of the sciatic nerve: new concepts in surgical therapy. J Spinal Disord Tech 2002;15:436–9.
Alberto Di Martino, MD, PhD Nicola Papapietro, MD Vincenzo Denaro, MD Department of Orthopaedics and Trauma Surgery University Campus Bio-Medico of Rome Via Alvaro del Portillo, 200 Rome 00128, Italy FDA device/drug status: Not applicable. Author disclosures: ADM: Nothing to disclose. NP: Nothing to disclose. VD: Nothing to disclose.
Figure. Sciatic nerve compression by a gluteal vein varicosity. Coronal (Left) MRI showing the varicosity of the left gluteal vein (arrows); the axial images (Right) show the contact of the sciatic nerve (arrow) with the varicose vein, just behind the left hip. MRI, magnetic resonance imaging. 1529-9430/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2014.03.008