PMC7265352_01
Preoperative T2-weighted magnetic resonance imaging in (a) sagittal and (b) axial views demonstrating the left-sided lateral recess epidural venous plexus at the adjacent level above a fusion mimicking a herniated disk associated with adjacent segment disease.
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F1
The MRI showed what appeared to be an L4-L5 left-sided disk herniation above the level of her prior fusion (i.e., adjacent L4-L5 segment disk disease) [Figure 1].
Intraoperative view down the minimally invasive tubular retractor showing (a) the lateral edge of the dural and nerve root with cottonoids and Surgicel  hemostatic material at both the nerve root shoulder and axilla after encountering copious venous bleeding. (b) View of the nerve root after exploration which demonstrated no herniated disk bulge or fragment.
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F2
Due to the fragility of the plexus and recurrent venous bleeding, multiple hemostatic agents were repeatedly employed to control the bleeding [Figure 2].
(a) Preoperative and (b) postoperative T2-weighted magnetic resonance imaging showing resolution of the epidural venous plexus after surgical intervention, confirming its etiology as the source of radiculopathy.
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F3
She was discharged on postoperative day 1 after a follow-up MRI confirmed an EVP as the ultimate etiology of her radiculopathy [Figure 3].