Diagnostic approaches for lumbar epidural varix causing radiculopathy: a systematic review

Abstract

Lumbosacral radiculopathy, commonly caused by disc protrusion or joint hypertrophy, can also stem from lumbar epidural varix (LEV), a rare condition involving vertebral venous plexus dilation. This systematic review evaluates the diagnostic approaches used to identify LEVs in patients presenting with radiculopathy, with particular emphasis on imaging modalities and clinical diagnostic strategies. Using the PICO framework, studies from January 2014 to June 2024 were systematically reviewed. MEDLINE, CINAHL, PubMed, and Embase were searched for peer-reviewed articles in English. Included studies examined diagnostic methods used to identify LEVs, including imaging modalities such as magnetic resonance imaging (MRI), CT myelography, and venospondylography, as well as clinical findings reported in affected patients. Data synthesis focused on diagnostic accuracy parameters and treatment outcomes following surgical interventions. Seven studies met the inclusion criteria, involving 109 patients with LEV-related radiculopathy. MRI demonstrated high sensitivity (87%–100%) and specificity (80%–95%) in identifying varices and associated neural compression. Surgical interventions, including laminectomy and microsurgical techniques, consistently led to symptom resolution and minimal recurrence rates. This review underscores MRI’s efficacy in diagnosing LEV and guiding effective surgical management, despite diagnostic challenges. Early and accurate diagnosis through comprehensive clinical and imaging evaluations is crucial for optimizing therapeutic strategies and improving patient outcomes in LEV-related radiculopathy.