Case Report: Acute Sciatica as Presentation of Vena Cava Thrombosis and Occlusion

Introduction: Low back pain is a highly ubiquitous symptom. Common pathological causes include muscle strain, vertebral fractures, malignancy, or infection. Approximately 78.5% of new patients at a spine surgery clinic reported low back pain as their chief complaint. People with physically demanding jobs, smokers, poor diet, vascular diseases, and obese individuals are at significant risk of developing low back pain. Most people with new episodes of low back pain recover. However, recurrence is common, and low back pain becomes persistent and disabling. Cost, healthcare use, and social systems may not provide adequate support for individuals with chronic pain, leading to an increased burden on families, hospitals, and businesses.

Methods: The case report was based on a single patient at Jefferson Hospital and reviewed through Epic Hyperspace. The patient was de-identified, and relevant clinical information such as patient history, imaging, and treatment intervention was gathered and reported.

Results: In cases of back pain with atypical presentations, it is crucial to give a comprehensive evaluation to uncover underlying causes. The patient's initial presentation of back pain, along with shortness of breath and unusual erection, warrants other possible etiologies besides back pain. In this case, elevated venous pressure causes fluid to leak from the capillaries into the interstitial space, leading to edema and radiculopathies by stretching the spinal nerves.

Conclusion : From a neurosurgical perspective, the concern was an MRI finding that resembled an AV fistula in the spine with dilated veins and presented as back pain, erection with standing, bilateral leg swelling, and gaining 20-27 pounds in three days. This case highlights the importance of clinicians being aware of the potential for back pain with unique etiologies such as vascular pathologies.