Benign extradural vascular neoplasm mimicking lumbar disc herniation: a case presenting with L5 radiculopathy

Abstract Background Benign spinal extradural vascular neoplasms are rare lesions that may present with radiculopathy and mimic common degenerative lumbar pathologies. Misinterpretation of imaging findings may lead to an incorrect preoperative diagnosis. Case presentation A 47-year-old woman presented with a three-year history of low back pain and progressive right leg pain consistent with L5 radiculopathy. Lumbar MRI demonstrated a right-sided L5–S1 lesion interpreted preoperatively as an extruded disc fragment. Surgical exploration revealed a highly vascular, hemorrhagic extradural mass compressing the L5 nerve root. The lesion was completely excised. Histopathological examination demonstrated a benign vascular neoplasm without features of arteriovenous malformation. Postoperatively, the patient experienced complete resolution of symptoms. Conclusion Benign extradural vascular neoplasms, although rare, should be considered in the differential diagnosis of lumbar radiculopathy, particularly when imaging features are atypical. Awareness of this diagnostic pitfall may help avoid intraoperative complications and optimize surgical outcomes.