Retroperitoneal hematoma: A rare complication of percutaneous pedicle screw in an osteoporotic patient
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kanagawa, Japan.
Kohei Yamamoto, Department of Neurosurgery, Kawasaki Saiwai Hospital, Kanagawa, Japan.
DOI:10.25259/SNI_701_2023Copyright: © 2023 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Kohei Yamamoto, Hidenori Matsuoka, So Ohashi, Kyohei Yamashiro, Kenta Kazami, Yusuke Hirokawa, Michihisa Narikiyo, Hirokazu Nagasaki, Yoshifumi Tsuboi. Retroperitoneal hematoma: A rare complication of percutaneous pedicle screw in an osteoporotic patient. 22-Sep-2023;14:345
How to cite this URL: Kohei Yamamoto, Hidenori Matsuoka, So Ohashi, Kyohei Yamashiro, Kenta Kazami, Yusuke Hirokawa, Michihisa Narikiyo, Hirokazu Nagasaki, Yoshifumi Tsuboi. Retroperitoneal hematoma: A rare complication of percutaneous pedicle screw in an osteoporotic patient. 22-Sep-2023;14:345. Available from: https://surgicalneurologyint.com/surgicalint-articles/12564/
Background: Percutaneous pedicle screw (PPS) placement is an established technique for minimally invasive surgery. However, life-threatening hematomas may occur in osteoporotic patients undergoing percutaneous screw placement.
Case Description: An 80-year-old female with an osteoporotic T10 chance fracture developed a life-threatening hematoma following a T8–L3 posterior fusion performed with PPS. Prompt angiography diagnosed a life-threatening hematoma attributed to laceration of the left third lumbar artery occurring following pedicle screw (PS) placement into an osteoporotically fractured left L3 transverse process. This was immediately and successfully embolized.
Conclusion: An 80-year-old female with multiple lumbar osteoporotic fractures developed a life-threatening hematoma during a T8–L3 PS fusion. When the lumbar computed tomography angiography diagnosed a laceration of the left L3 lumbar artery, immediate transarterial embolization proved life-saving.
Keywords: Lumbar artery injury, Percutaneous pedicle screw, Transarterial embolization, Transverse process fracture, Retroperitoneal hematoma
Lumbar artery injuries are rare following percutaneous pedicle screw (PPS) placement. Here, an 80-year-old female with multiple lumbar osteoporotic vertebral fractures developed a life-threatening retroperitoneal hematoma following pedicle screw (PS) laceration of the left L3 lumbar artery at the site of a left L3 osteoporotic transverse process (TP) fracture. Once the computed tomography (CT) angiogram diagnosed the site of the vascular injury, the patient successfully underwent lift-saving transarterial embolization (TAE).
An 80-year-old osteoporotic female with a prior history of a T12 balloon kyphoplasty had fallen 10 days earlier. The thoracolumbar CT showed the left TP fractures from L1 to 3, a T10 chance fracture, and multiple osteoporotic fractures involving the T11, T12, L2, L3, and L4 vertebrae [
PPS T8–L3 fusion resulting in left L3 lumbar artery laceration (site of left L3 TP osteoporotic/traumatic fracture)
With an unstable vertebral fracture of T10, the patient underwent a minimally invasive thoracolumbar T8–L3 PPS fusion under C-arm fluoroscopy [
TP fractures can lead to lumbar artery injuries
TP fractures can lead to lumbar artery injuries, including pseudoaneurysm formation, following spinal trauma and/or spine surgery.[
History of iatrogenic lumbar artery injury with lumbar PS insertion
Although iatrogenic lumbar artery injuries due to PS insertion are rare, we found 6 such life-threatening complications in the literature [
An 80-year-old female developed a life-threatening retroperitoneal hematoma following a PPS/fusion (T8–L3) that included placing a PS into an osteoporotic left L3 TP; immediate resuscitation and TAE proved lifesaving.
Patient’s consent not required as patient’s identity is not disclosed or compromised.
There are no conflicts of interest.
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The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
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