Presentation
Bilateral, progressive lower limb radicular pain, newly developed fecal incontinence.
Patient Data
diffuse degenerative changes and signs of multisegmental lower lumbar advanced disc disease, with multisegmental disc bulge
about 4 mm anterior spondylolisthesis of the L3 vertebra (Meyerding I.)
simultaneous L3-4 disc bulge with a slight right-sided predominance
listhesis and disc bulge cause a marked narrowing of the spinal canal (AP diameter: 5 mm), with the liquor space around the descending roots becoming virtual, indicative of compression
proximal spinal venous congestion, visible as a dilated tangle of vessels with flow voids
marked narrowing of the right L3-4 neuroforamina with compression of the exiting root
moderate bilateral L5-S1 neuroforaminal stenosis
Case Discussion
Spinal venous congestion is one of the possible sequelae of symptomatic spinal canal stenosis, and also signals the presence of significant cauda equina compression.