European Spine Journal - 2026-07-09 - Journal Article; Review
Vertebral-spinal endometriosis: a comprehensive narrative review of clinical presentation, diagnostic challenges, and treatment outcomes.
Khadmy A, Cohen I, Ben Uri A, Gutman G, Harel R, Ahuja S
Topics
Key Takeaway
Vertebral-spinal endometriosis (n=14 cases, 1968–2025) presents most commonly with radicular pain (71.4%) and lumbar involvement (78.5%), with 57.1% achieving near-complete symptom resolution regardless of treatment modality.
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Summary
This PRISMA-compliant narrative review synthesized all published case reports of histologically or radiologically confirmed vertebral-spinal endometriosis (VSE) from 1968–2025 to characterize presentation, diagnosis, and treatment outcomes. Lumbar involvement predominated (78.5%), MRI was the primary diagnostic tool (92.9%), and histopathology confirmed diagnosis in 13/14 cases. Treatment varied widely—decompression alone (42.9%), hormonal therapy alone (21.4%), or combined (35.7%)—with 57.1% achieving near-complete symptom resolution and recurrence in 2/14 cases.
Key Limitation
With only 14 cases spanning 57 years, the dataset is too small and heterogeneous to support any comparative analysis of treatment modalities or to identify predictors of recurrence.
Original Abstract
BACKGROUND CONTEXT
Endometriosis is a chronic inflammatory disease characterized by endometrial-like tissue outside the uterus, affecting approximately 10% of women of reproductive age. While typically confined to the pelvis, lesions may occur in extra-pelvic sites, including the vertebral spine. Vertebral-spinal endometriosis (VSE) is extremely rare and often presents with nonspecific pain or neurological symptoms, making diagnosis and treatment challenging.
PURPOSE
To comprehensively review the clinical presentations, diagnostic approaches, and treatment outcomes of VSE, to improve clinical awareness and guide management strategies in spine practice.
STUDY DESIGN
Comprehensive review of published case reports, conducted in accordance with PRISMA 2020 guidelines.
PATIENT SAMPLE
Fourteen female patients, aged 20-50 years, with histologically or radiologically confirmed VSE reported in published case reports between 1968 and 2025.
OUTCOME MEASURES
Primary outcomes included symptom resolution or improvement following treatment. Secondary measures included type and location of spinal lesions, diagnostic modalities, histological confirmation, and recurrence rates.
METHODS
A comprehensive search of PubMed, Google Scholar, and the Cochrane Library identified eligible case reports. Two reviewers screened studies, extracted data, and resolved disagreements by consensus. Findings were synthesized narratively, and data are presented descriptively as counts, proportions, and simple summary statistics.
RESULTS
Of 188 records screened, 14 met the inclusion criteria. Patients were reproductive-age women (mean age 37.9 ± 8.2 years). A documented prior diagnosis of pelvic endometriosis was present in 4 of 14 cases, although eight patients (8/14 57.1%) had symptoms related to menstrual correlation. The most frequent presenting symptoms were radicular pain (10/14, 71.4%), back or lumbosacral pain (9/14, 64.2%), and urinary or bladder dysfunction (5/14, 35.7%). Lesions predominantly involved the lumbar spine (11/14, 78.5%), with rare thoracic (1/14, 7.1%) and sacral foraminal (2/14, 14.3%) cases. MRI was the primary diagnostic modality (13/14, 92.9%). Histopathology confirmed endometriosis in 13 of 14 cases. Treatments included spinal decompression or lesion excision alone (6/14, 42.9%), hormonal therapy alone (3/14, 21.4%), and combined surgery plus hormonal therapy (5/14, 35.7%). Overall, 8 of 14 patients (57.1%) became symptom-free or nearly symptom-free, and 6 of 14 (42.9%) had partial but clinically meaningful improvement. Recurrent spinal endometriosis was documented in 2 of 14 cases over follow-up periods ranging from 6 to 30 months.
CONCLUSIONS
Vertebral-spinal endometriosis presents with diverse symptoms and variable treatment responses. MRI and histopathology are essential for diagnosis. The small evidence base precludes definitive conclusions regarding whether lesion location or treatment modality predicts outcomes.