Compression of the S1 Nerve Root by an Extradural Vascular Malformation: A Case Report and Discussion of Atypical Causes of Lumbar Radiculopathy

ABSTRACT

We present a case of lumbar radiculopathy due to a vascular malformation in the lumbar spine and discuss various causes of atypical lumbar radiculopathy. Lumbar radiculopathy is a condition of neurologic deficits and painful symptoms of the lower extremities due to nerve root compression, most commonly at the L5 and S1 levels. Several factors contribute to lumbar radiculopathy, including intervertebral disc herniation, foraminal stenosis, and spinal instability. There are also a number of atypical causes, including medication side effects or metabolic disorders, which produce symptoms of radiculopathy but do not involve compression of the nerve root. Anatomic variations in the nerve roots or vascular supply surrounding the nerve root may also increase the risk of developing radiculopathy and serve as an obstacle to interpreting imaging during a preoperative workup. A 38-year-old woman presented with sudden onset radicular symptoms in her right lower extremity. Lumbar magnetic resonance imaging demonstrated a right-sided L5-S1 extruded nucleus pulposus. Her symptoms failed to improve after conservative management so she underwent surgical decompression of L4-S1. Intraoperatively, we discovered an extensive, extradural vascular malformation present at the L5-S1 level and believed this to be the true cause of her radiculopathy. This case represents an atypical cause of lumbar radiculopathy and demonstrates the importance of considering atypical causes during diagnostic workup and preoperative planning.