Psoas hematoma as a rare complication of posterior lumbar interbody fusion: a case report
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CASE REPORT
Psoas hematoma as a rare complication of posterior lumbar interbody fusion: a case report Bo Deng, Hai Nan Hong, Xin Bing Feng, Zheng Hua Hong*, Guo Ping Cai and Dun Hong
Abstract Background: Psoas hematoma rarely occurs in patients with spondylolisthesis who undergo posterior lumbar interbody fusion (PLIF) surgery. Case presentation: Here we reported a case of a 57-year-old male patient diagnosed with spondylolisthesis who underwent PLIF at the local hospital. Seven days post-surgery, abdominal pain occurred, and the pain in the right lower limb gradually increased. The computerized tomography (CT) indicated a formation of hematoma around the psoas muscle. Digital-subtraction angiography (DSA) suggested a vascular injury, a rupture of the right segmental artery of the lumbar vertebral level 4. The patient then received DSA vascular embolization, after which the lower lumbar segmental artery active bleeding was stopped. One month after discharge, the abdominal hematoma was gradually absorbed, and the pain in the waist, leg, and abdomen disappeared. Conclusion: Symptoms such as abdominal pain, abdominal distension, and exacerbation of lower limb pain, may suggest the occurrence of psoas hematoma after PLIF. DSA vascular embolization is suggested as the first treatment approach for this type of complication. Keywords: Posterior lumbar interbody fusion, Psoas hematoma, Complication Background Degenerative lumbar spondylolisthesis is a disorder caused by the slip of one vertebral body over the other. It commonly occurs in people who are over 50 years old and is often associated with lumbar spinal stenosis [1, 2]. Posterior lumbar interbody fusion is widely used in the treatment of lumbar degenerative diseases, such as spondylolisthesis and lumbar spinal stenosis [3, 4]. Yet, this type of surgery is associated with several complications, such as abdominal large blood vessel damage, nerve root injury and epidural hematoma [5, 6]. Kalanithi et al.[7] performed statistical analysis of 66,601 patients with spondylolisthesis who underwent lumbar interbody *Correspondence: [email protected] Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
fusion, reporting that incision hematoma (5.36%), respiratory complications (13.1%), cardiovascular system complications (1.24%), nerve injury (0.80%) and deep vein thrombosis (0.63%) were the most common complications. Iatrogenic vascular injury rarely occurs after spinal surgery and has an incidence of 0.03% ~ 0.17% [8]. The lower lumbar segmental artery originates from the posterior wall of the abdominal aorta and follows the side of the vertebral body to the posterolateral side. Psoas hematoma occurs secondary to trauma and iatrogenic etiology [9, 10]. If the position of the pedicle screw is poorly placed, the segmental artery can be easily damaged. Here we reported a single case of a patient with psoas hematoma caused by the pedicle screw after PLIF so as to share our experience wit
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