Lumbar Spinal Epidural Varices Causing Acute Bilateral Lower Limb Radiculopathy

Case: A 61-year-old male patient presented with back pain and bilateral lower limb radicular pain. A Magnetic Resonance Imaging (MRI) scan of the lumbar spine was suggestive of engorged epidural veins behind the L5 vertebral body causing severe cauda equina compression. A venous Doppler scan demonstrated thrombosis of the inferior vena cava, which was identified as the primary pathology. He was started on anticoagulation, after which his radicular symptoms improved significantly. The patient was asymptomatic at the time of final follow-up at 1 year. Conclusion: Epidural varices can rarely present with lumbar radiculopathy mimicking an acute disk prolapse clinically and radiologically. Careful interpretation of the MRI scan will ensure proper diagnosis and avoid unnecessary surgery.