1226 - Lumbar Radiculopathy Secondary to Basivertebral Plexus Engorgement: A Case Report

Case Diagnosis: L2-3 radiculopathy secondary to basivertebral plexus engorgement

Case Description: A 38-year-old female with autonomic neuropathy, migraines, Ehlers Danlos Syndrome (EDS), and Postural Orthostatic Tachycardia Syndrome (POTS) is being evaluated for low back pain. Disabled since 2017 due to EDS/POTS, she developed severe left low back pain radiating down her posterior thigh from a stepstool mishap one month ago since the initial encounter. On examination, pain worsened with Valsalva and forward flexion. At this time, she had an MRI of her lumbar spine with and without IV contrast done, which showed basivertebral plexus engorgement at L2-L3, within the left neural foramen.

Discussions: The basivertebral plexus is a network of veins that surrounds the vertebral bodies within the spine. These veins are part of the venous drainage system of the spinal column. When the basivertebral plexus becomes engorged or enlarged, it can potentially lead to compression or irritation of adjacent neural structures, such as nerve roots, which can result in radiculopathy. Radiculopathy can occur at various levels of the spine and is often associated with conditions like herniated discs, spinal stenosis, and degenerative disc disease. The relationship between basivertebral plexus engorgement and radiculopathy is not fully understood and might not be a well-established or widely recognized concept in the medical community. While vascular factors, including venous congestion, can contribute to nerve irritation and pain, other structural and biomechanical factors are often considered primary causes of radiculopathy.

Conclusions: After excluding other clinical diagnoses based on the history, physical exam, and MRI of the lumbar spine with and without contrast, we report a rare case of basivertebral plexus engorgement causing L2-L3 radiculopathy. Further studies and advancements in medical understanding are needed to clarify the significance of basivertebral plexus engorgement in the context of radiculopathy and to guide more targeted and effective treatment approaches for individuals experiencing these symptoms.