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Surgical Treatment of Endometriosis in the Lumbar Spine

Received: 16 July 2022     Accepted: 11 August 2022     Published: 24 August 2022
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Abstract

Introduction: Endometriosis consists of the presence of endometrial tissue outside the uterus most often in the pelvic peritoneum, ovaries, and rectovaginal septum. It can present with low back pain and radiculopathy, being its presentation within the spinal canal very rare. This paper reports the case of a patient with endometriosis within the spinal canal who presented with chronic low back pain that evolves to sciatica, showing its rarity and relevance as a differential diagnosis of low back pain. Case Report: A 32 years old, female patient, search attendance complaining of low back pain that started 1 year ago. Her pain was in the left S1 territory and had worsening in a cyclical manner. Magnetic resonance [MR] of the lumbosacral region demonstrated small nodular epidural lesion at the S1 level, with well-defined limits, located along the posterior contour of the vertebral body of S1, determining discrete local bone remodeling and bone marrow edema in this topography. With these features, patient was submitted to surgical treatment. The capsule of the cyst was removed and send to pathology examination. Pathology examination revealed endometriosis with focal stroma in fibroconnective tissue with old hemorrhage. With all of this in mind, we can affirm that the case we present is very rare, with few similar publications, and that’s highlight its originality. Conclusion: As illustrated by our case, spine surgeons must be aware of this pathology. Treatment options depend on the patient's symptoms and planning for pregnancy, with total removal of endometrial tissue being the ideal treatment targeted by the neurosurgeon.

Published in International Journal of Neurosurgery (Volume 6, Issue 2)
DOI 10.11648/j.ijn.20220602.13
Page(s) 44-47
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Endometriosis, Spinal Canal, Lumbar Pain

References
[1] Audebert A, Petousis S, Margioula-Siarkou C, Ravanos K, Prapas N, Prapas Y. Anatomic distribution of endometriosis: A reappraisal based on series of 1101 patients. Eur J Obstet Gynecol Reprod Biol [Internet]. 2018; 230: 36–40. Available from: https://doi.org/10.1016/j.ejogrb.2018.09.001
[2] Martin BR. Multimodal Care for Headaches, Lumbopelvic Pain, and Dysmenorrhea in a Woman With Endometriosis: A Case Report: Acupuncture, Turmeric [Curcuma Longa Black Cohosh [Cimicifuga racemose], Bromelain [Ananas comosus], Magnesium, B Vitamins May Alleviate Sympto. J Chiropr Med [Internet]. 2021; 20 [3]: 148–57. Available from: https://doi.org/10.1016/j.jcm.2021.10.002
[3] Guedes F, Brown RS, Lourenço Torrão-Júnior FJ, Siquara-de-Sousa AC, Pires Amorim RM. Nondiscogenic Sciatica: What Clinical Examination and Imaging Can Tell Us? World Neurosurg. 2020; 134: e1053–61.
[4] Uppal J, Sobotka S, Jenkins AL. Cyclic Sciatica and Back Pain Responds to Treatment of Underlying Endometriosis: Case Illustration. World Neurosurg [Internet]. 2017; 97: 760. e1-760.e3. Available from: http://dx.doi.org/10.1016/j.wneu.2016.09.111
[5] Steinberg JA, Gonda DD, Muller K, Ciacci JD. Endometriosis of the conus medullaris causing cyclic radiculopathy: Case report. J Neurosurg Spine. 2014; 21 [5]: 799–804.
[6] Scott WW, Ray B, Rickert KL, Madden CJ, Raisanen JM, Mendelsohn D, et al. Functional müllerian tissue within the conus medullaris generating cyclical neurological morbidity in an otherwise healthy female. Child’s Nerv Syst. 2014; 30 [4]: 717–21.
[7] Siquara De Sousa AC, Capek S, Amrami KK, Spinner RJ. Neural involvement in endometriosis: Review of anatomic distribution and mechanisms. Clin Anat. 2015; 28 [8]: 1029–38.
[8] Dongxu Z, Fei Y, Xing X, Bo-Yin Z, Qingsan Z. Low back pain tied to spinal endometriosis. Eur Spine J. 2014; 23 [SUPPL.2]: 214–7.
[9] Zanatta A, Rosin MM, Machado RL, Cava L, Possover M. Laparoscopic Dissection and Anatomy of Sacral Nerve Roots and Pelvic Splanchnic Nerves. J Minim Invasive Gynecol [Internet]. 2014; 21 [6]: 982–3. Available from: http://dx.doi.org/10.1016/j.jmig.2014.07.006
[10] Manganaro L, Porpora MG, Vinci V, Bernardo S, Lodise P, Sollazzo P, et al. Diffusion tensor imaging and tractography to evaluate sacral nerve root abnormalities in endometriosis-related pain: A pilot study. Eur Radiol. 2014; 24 [1]: 95–101.
[11] Cricco C, Daugenti A, Angilecchia D, Ceron D. Differential diagnosis of endometriosis in patient with nonspecific low back pain: A case report. J Bodyw Mov Ther [Internet]. 2021; 27 [2021]: 227–32. Available from: https://doi.org/10.1016/j.jbmt.2021.02.019
[12] Zegrea A, Kirss J, Pinta T, Rautio T, Varpe P, Kairaluoma M, et al. Outcomes of sacral neuromodulation for chronic pelvic pain: a Finnish national multicenter study. Tech Coloproctol [Internet]. 2020; 24 [3]: 215–20. Available from: https://doi.org/10.1007/s10151-020-02148-2
[13] Phan VT, Stratton P, Tandon HK, Sinaii N, Aredo J V., Karp BI, et al. Widespread myofascial dysfunction and sensitisation in women with endometriosis-associated chronic pelvic pain: A cross-sectional study. Eur J Pain [United Kingdom]. 2021; 25 [4]: 831–40.
[14] Jeswani. Endometriosis in the Lumbar Plexus Mimicking a Nerve Sheath Tumor. World J Oncol. 2011; 2 [6]: 314–8.
[15] Jackson B, Telner DE. Managing the misplaced: Approach to endometriosis. Can Fam Physician. 2006; 52 [11]: 1420–4.
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  • APA Style

    Rodrigues Jr José Carlos, Bortholin da Silva Vithor Ely, Batista de Sousa Aldimar, Aguillar Condori Luís Alberto. (2022). Surgical Treatment of Endometriosis in the Lumbar Spine. International Journal of Neurosurgery, 6(2), 44-47. https://doi.org/10.11648/j.ijn.20220602.13

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    ACS Style

    Rodrigues Jr José Carlos; Bortholin da Silva Vithor Ely; Batista de Sousa Aldimar; Aguillar Condori Luís Alberto. Surgical Treatment of Endometriosis in the Lumbar Spine. Int. J. Neurosurg. 2022, 6(2), 44-47. doi: 10.11648/j.ijn.20220602.13

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    AMA Style

    Rodrigues Jr José Carlos, Bortholin da Silva Vithor Ely, Batista de Sousa Aldimar, Aguillar Condori Luís Alberto. Surgical Treatment of Endometriosis in the Lumbar Spine. Int J Neurosurg. 2022;6(2):44-47. doi: 10.11648/j.ijn.20220602.13

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  • @article{10.11648/j.ijn.20220602.13,
      author = {Rodrigues Jr José Carlos and Bortholin da Silva Vithor Ely and Batista de Sousa Aldimar and Aguillar Condori Luís Alberto},
      title = {Surgical Treatment of Endometriosis in the Lumbar Spine},
      journal = {International Journal of Neurosurgery},
      volume = {6},
      number = {2},
      pages = {44-47},
      doi = {10.11648/j.ijn.20220602.13},
      url = {https://doi.org/10.11648/j.ijn.20220602.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20220602.13},
      abstract = {Introduction: Endometriosis consists of the presence of endometrial tissue outside the uterus most often in the pelvic peritoneum, ovaries, and rectovaginal septum. It can present with low back pain and radiculopathy, being its presentation within the spinal canal very rare. This paper reports the case of a patient with endometriosis within the spinal canal who presented with chronic low back pain that evolves to sciatica, showing its rarity and relevance as a differential diagnosis of low back pain. Case Report: A 32 years old, female patient, search attendance complaining of low back pain that started 1 year ago. Her pain was in the left S1 territory and had worsening in a cyclical manner. Magnetic resonance [MR] of the lumbosacral region demonstrated small nodular epidural lesion at the S1 level, with well-defined limits, located along the posterior contour of the vertebral body of S1, determining discrete local bone remodeling and bone marrow edema in this topography. With these features, patient was submitted to surgical treatment. The capsule of the cyst was removed and send to pathology examination. Pathology examination revealed endometriosis with focal stroma in fibroconnective tissue with old hemorrhage. With all of this in mind, we can affirm that the case we present is very rare, with few similar publications, and that’s highlight its originality. Conclusion: As illustrated by our case, spine surgeons must be aware of this pathology. Treatment options depend on the patient's symptoms and planning for pregnancy, with total removal of endometrial tissue being the ideal treatment targeted by the neurosurgeon.},
     year = {2022}
    }
    

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  • TY  - JOUR
    T1  - Surgical Treatment of Endometriosis in the Lumbar Spine
    AU  - Rodrigues Jr José Carlos
    AU  - Bortholin da Silva Vithor Ely
    AU  - Batista de Sousa Aldimar
    AU  - Aguillar Condori Luís Alberto
    Y1  - 2022/08/24
    PY  - 2022
    N1  - https://doi.org/10.11648/j.ijn.20220602.13
    DO  - 10.11648/j.ijn.20220602.13
    T2  - International Journal of Neurosurgery
    JF  - International Journal of Neurosurgery
    JO  - International Journal of Neurosurgery
    SP  - 44
    EP  - 47
    PB  - Science Publishing Group
    SN  - 2640-1959
    UR  - https://doi.org/10.11648/j.ijn.20220602.13
    AB  - Introduction: Endometriosis consists of the presence of endometrial tissue outside the uterus most often in the pelvic peritoneum, ovaries, and rectovaginal septum. It can present with low back pain and radiculopathy, being its presentation within the spinal canal very rare. This paper reports the case of a patient with endometriosis within the spinal canal who presented with chronic low back pain that evolves to sciatica, showing its rarity and relevance as a differential diagnosis of low back pain. Case Report: A 32 years old, female patient, search attendance complaining of low back pain that started 1 year ago. Her pain was in the left S1 territory and had worsening in a cyclical manner. Magnetic resonance [MR] of the lumbosacral region demonstrated small nodular epidural lesion at the S1 level, with well-defined limits, located along the posterior contour of the vertebral body of S1, determining discrete local bone remodeling and bone marrow edema in this topography. With these features, patient was submitted to surgical treatment. The capsule of the cyst was removed and send to pathology examination. Pathology examination revealed endometriosis with focal stroma in fibroconnective tissue with old hemorrhage. With all of this in mind, we can affirm that the case we present is very rare, with few similar publications, and that’s highlight its originality. Conclusion: As illustrated by our case, spine surgeons must be aware of this pathology. Treatment options depend on the patient's symptoms and planning for pregnancy, with total removal of endometrial tissue being the ideal treatment targeted by the neurosurgeon.
    VL  - 6
    IS  - 2
    ER  - 

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Author Information
  • Neurosurgery Team, Assun??o Hospital, S?o Bernardo do Campo, S?o Paulo, Brazil

  • Department of Neurosurgery, Heliópolis Hospital, S?o Paulo, Brazil

  • Neurosurgery Team, Assun??o Hospital, S?o Bernardo do Campo, S?o Paulo, Brazil

  • Neurosurgery Team, Assun??o Hospital, S?o Bernardo do Campo, S?o Paulo, Brazil

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