{"paper_id":"31b01d23-6489-48c9-9ac7-65bb6e76426a","body_text":"Abstract\nBackground context\nEndometriosis 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.\nPurpose\nTo comprehensively review the clinical presentations, diagnostic approaches, and treatment outcomes of VSE, to improve clinical awareness and guide management strategies in spine practice.\nStudy design\nComprehensive review of published case reports, conducted in accordance with PRISMA 2020 guidelines.\nPatient sample\nFourteen female patients, aged 20–50 years, with histologically or radiologically confirmed VSE reported in published case reports between 1968 and 2025.\nOutcome measures\nPrimary outcomes included symptom resolution or improvement following treatment. Secondary measures included type and location of spinal lesions, diagnostic modalities, histological confirmation, and recurrence rates.\nMethods\nA 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.\nResults\nOf 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.\nConclusions\nVertebral-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.\nSimilar content being viewed by others\nData availability\nNo datasets were generated or analysed during the current study.\nReferences\nKale A, s. Baydili KN, Keles E, Gundogdu E, Usta T, Oral E (2022) Comparison of Isolated Sciatic Nerve and Sacral Nerve Root Endometriosis: A Review of the Literature. J Minim Invasive Gynecol 29(8):943–951. https://doi.org/10.1016/j.jmig.2022.05.017\nYe H, Shen C, Quan Q, Xi M, Li L (2023) Endometriosis of the skeletal muscular system (ESMS): a systematic review. BMC Womens Health 23(1):1–13. https://doi.org/10.1186/s12905-023-02184-8\nFerrero S, Gazzo I, Crosa M et al (2024) Best Practice & Research Clinical Obstetrics & Gynaecology Impact of surgery for endometriosis on the outcomes of in vitro fertilization. Best Pract Res Clin Obstet Gynaecol 95(March):102496. https://doi.org/10.1016/j.bpobgyn.2024.102496\nMonnin N, Fattet AJ, Koscinski I, Endometriosis (2023) Update of Pathophysiology, (Epi) Genetic and Environmental Involvement. Biomedicines 11(3). https://doi.org/10.3390/biomedicines11030978\nCricco C, Daugenti A, Angilecchia D, Ceron D (2021) Differential diagnosis of endometriosis in patient with nonspecific low back pain: A case report. J Bodyw Mov Ther 27(2021):227–232. https://doi.org/10.1016/j.jbmt.2021.02.019\nSilva de Barros A, Mesquita Magalhães G, Darc de Menezes Braga L et al Musculoskeletal evaluation of the lower pelvic complex in women with endometriosis: A case-control study. Eur J Obstet Gynecol Reprod Biol. Published online 2024. https://doi.org/10.1016/j.ejogrb.2024.04.030\nGörtzen A, Hansten RL, Lang W, Veh RW (1995) Intraspinal endometriosis as a possible cause of recurrent back pain and leg monoparesis. Eur J Neurol 2(1):51–53. https://doi.org/10.1111/J.1468-1331.1995.TB00093.X\nSteinberg JA, Gonda DD, Muller K, Ciacci JD (2014) Endometriosis of the conus medullaris causing cyclic radiculopathy: Case report. J Neurosurg Spine 21(5):799–804. https://doi.org/10.3171/2014.7.SPINE14117\nDongxu Z, Fei Y, Xing X, Bo-Yin Z, Qingsan Z (2014) Low back pain tied to spinal endometriosis. Eur Spine J 23(SUPPL2):214–217. https://doi.org/10.1007/s00586-013-2988-x\nLombardo L, Mateos JH, Barroeta FF (1968) Subarachnoid hemorrhage due to endometriosis of the spinal canal. Neurology 18(5):423–426. https://doi.org/10.1212/wnl.18.5.423\nGomez D, Kottegoda G, Gunawardana T, Pirakash P, Attanayake D (2023) Recurrent intramedullary endometriosis of the conus medullaris: A case report of diagnostic pitfalls and a review of literature. Int J Surg Case Rep 113(November 2023):109041. https://doi.org/10.1016/j.ijscr.2023.109041\nNagra I, Stirling AJ, James SLJ (2010) A 45-year-old woman with a pre-sacral mass lesion: diagnosis and discussion. Skeletal Radiol 39(2):199–200. https://doi.org/10.1007/s00256-009-0832-5\nBeck TB, Carbonar MBF, Hanel R, Beck RT, Carbonar F (2021) Intramedullary Endometriosis of the Conus Medullaris. Cureus 13(4):13–16. https://doi.org/10.7759/cureus.14581\nPage MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLoS Med 18(3). https://doi.org/10.1371/JOURNAL.PMED.1003583\nCui LL, Cao J, Bin, Fan GG, Lin XY, Xu K (2014) Development of intraspinal ectopic endometrial tissue in connection with tethered cord syndrome. Intern Med 53(23):2741–2743. https://doi.org/10.2169/internalmedicine.53.2266\nQu LR, Zhao DX, Zhong YP, Guo K, Li-rong B (2011) 椎管内子宫内膜异位侵及椎骨一例 中华病理学杂志 40(12):846–847. https://doi.org/10.3760/CMA.J.ISSN.0529-5807.2011.12.014\nSun Z, Wang Y, Zhao L, Ma L (2002) Intraspinal endometriosis: a case report. Chin Med J (Engl). 115(4):622–3. PMID: 12133314\nAgrawal A, Shetty BJP, Makannavar JH, Shetty L, Shetty J, Shetty V (2006) Intramedullary endometriosis of the conus medullaris: Case report. Neurosurgery 59(2):2–4. https://doi.org/10.1227/01.NEU.0000223375.23617.DC\nJeswani (2011) Endometriosis in the Lumbar Plexus Mimicking a Nerve Sheath Tumor. World J Oncol 2(6):314–318. https://doi.org/10.4021/wjon413w\nChan-Tiopianco M, Huang CY, Jiang LY, Lai CR, Wang PH, Chen YJ (2020) Endometriosis of the Paralumbar Muscles: A Case Report and Literature Review. Gynecol Minim Invasive Ther 9(3):170. https://doi.org/10.4103/GMIT.GMIT_81_19\nSahu RN, Tungaria A, Pal L, Kumar R (2013) Endometriosis of conus medullaris: A case report. Br J Neurosurg 27(6):842–844. https://doi.org/10.3109/02688697.2013.795519\nLemos N, Kamergorodsky G, Ploger C, Castro R, Schor E, Girão M (2012) Sacral Nerve Infiltrative Endometriosis Presenting as Perimenstrual Right-sided Sciatica and Bladder Atonia: Case Report and Description of Surgical Technique. J Minim Invasive Gynecol 19(3):396–400. https://doi.org/10.1016/j.jmig.2012.02.001\nCromeens MG, Carey ET, Robinson WR, Knafl K, Thoyre S Timing, delays and pathways to diagnosis of endometriosis : a scoping review protocol. Published online 2021:1–6. https://doi.org/10.1136/bmjopen-2021-049390\nAuthor information\nAuthors and Affiliations\nContributions\nA.K. - Conception and design, Analysis and interpretation of data, Drafting of the manuscript, Administrative support.I.C. - Conception and design, Acquisition and data, Statistical analysisA.U. - Acquisition and data, Analysis and interpretation of dataG.G. - Critical revision of the manuscript for important intellectual content.R.H. - Drafting of the manuscript, Supervision. S.A. - Drafting of the manuscript, Administrative support.All authors reviewed the manuscript.\nCorresponding authors\nEthics declarations\nCompeting interests\nThe authors declare no competing interests.\nAdditional information\nPublisher’s note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nSupplementary Information\nBelow is the link to the electronic supplementary material.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nKhadmy, A., Cohen, I., Ben Uri, A. et al. Vertebral-spinal endometriosis: a comprehensive narrative review of clinical presentation, diagnostic challenges, and treatment outcomes. Eur Spine J (2026). https://doi.org/10.1007/s00586-026-10134-9\nReceived:\nRevised:\nAccepted:\nPublished:\nVersion of record:\nDOI: https://doi.org/10.1007/s00586-026-10134-9","source_license":"public-domain-us","license_restricted":false}