A case report of May-Thurner syndrome induced by anterior lumbar disc herniation: Novel treatment with radiofrequency thermocoagulation

RATIONALE: Lumbar degeneration-related May-Thurner syndrome (dMTS) is characterized by venous compression induced by degenerated lower lumbar structures. Treatment strategies for May-Thurner syndrome (MTS) include clearing the thrombus and correcting venous compression. Despite having different etiological factors from other MTS types, treatments for dMTS are similar, including endovascular angioplasty and continuous anticoagulation therapies. Thus, a particular treatment was designed herein to focus on compressive lumbar structures instead of intravenous management. PATIENT CONCERNS: A 59-year-old female patient with dMTS, which was induced by inferior vena cava (IVC) stenosis compressed by L4-5 anterior disc herniation. DIAGNOSIS: The patient was diagnosed with IVC stenosis and L4-5 lumbar disc herniation based on abdominal computed tomography, ultrasound, and lumbar magnetic resonance imaging findings. INTERVENTIONS: Radiofrequency thermocoagulation (RF) was applied to the patient to decrease the compression caused by anterior disc herniation. OUTCOMES: After surgery, the patient's swelling started to improve within 5 hours and completely diminished after 48 hours. Postsurgical abdominal ultrasound showed that her IVC patency increased by 20%. On follow-up, her leg symptoms did not recur at 12 months after surgery. LESSONS: We provided a novel idea in the treatment of dMTS, in which we shifted the treatment focus from endovascular patency restoration to extravascular decompression. Our case proved that RF was effective in treating dMTS, which is a complementary treatment modality to angioplasty.