An unusual cause of lumbar radiculopathy

摘要

A 37-year-old obese woman presented with a 2 year history of gradually worsening lumbar pain, worse at night, and 6 months of a right L5 radiculopathy. Lower limb neurological examination revealed normal tone, power and reflexes, with decreased sensation over the right L5 dermatome. Her past medical history was unremarkable; in particular, there was no history of a malignancy. MRI of the lumbar spine demonstrated a well-circumscribed elongated lesion in the right anterior epidural space extending from the L4 inferior endplate to the L5 inferior endplate (Fig. 1A-D). It had an axial dimension of 13 x 8 mm and a craniocaudal height of 34 mm. On a CT scan of the lumbar spine (pre- and delayed post-contrast) the lesion appeared to be of the same density as the common iliac vein (Fig. IE, F). The adjacent bone demonstrated very minor remodelling. An operation was indicated to obtain a histological diagnosis and to provide symptomatic relief. The patient underwent a right-sided L4/L5 medial facetectomy and L5 hemilaminectomy and the lesion was excised.