J Korean Neurosurg Soc.  2013 Oct;54(4):344-346. 10.3340/jkns.2013.54.4.344.

Delayed Retroperitoneal Hemorrhage due to Lumbar Artery Pseudoaneurysm after Lumbar Posterolateral Fusion

• Oh YM
• Choi HY
• Eun JP

• KMID: 1499342
• DOI: http://doi.org/10.3340/jkns.2013.54.4.344

Abstract

A 55-year-old female patient presented with lower back pain and neurogenic intermittent claudication and underwent L3-L4 posterolateral fusion. To prepare the bone fusion bed, the transverse process of L3 and L4 was decorticated with a drill. On the 9th post-operative day, the patient complained of a sudden onset of severe abdominal pain and distension. Abdominal computed tomography revealed retroperitoneal hematoma in the right psoas muscle and iatrogenic right L3 transverse process fracture. Lumbar spinal angiography showed the delayed hematoma due to rupture of the 2nd lumbar artery pseudoaneurysm and coil embolization was done at the ruptured lumbar artery pseudoaneusyrm. Since then, the patient's postoperative progress proceeded normally with recovery of the hemodynamic parameters.

Keyword

Lumbar artery; Spinal fusion; Posterolateral fusion

MeSH Terms

Abdominal Pain
Aneurysm, False*
Angiography
Arteries*
Female
Hematoma
Hemodynamics
Hemorrhage*
Humans
Intermittent Claudication
Low Back Pain
Middle Aged
Psoas Muscles
Rupture
Spinal Fusion

Figure

• 

  Fig. 1 A : Abdominal enhanced computerized tomography (CT) image showing retroperitoneal hematoma (arrow) in the right psoas muscle around L3 vertebral body. B : CT bone setting image shows the fracture of right L3 transverse process (arrow).

• 

  Fig. 2 A : Lumbar spinal angiography shows the delayed hematoma due to rupture of the 2nd lumbar artery pseudoaneurysm. B : Lumbar spinal angiography obtained after coil embolization shows no leakage of the contrast media.

• 

  Fig. 3 Two weeks follow-up CT shows the decreased retroperitoneal hematoma.

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  Fig. 4 The lower lumbar arteries can occasionally originate from a common trunk near the midline of the posterior aorta, and these vessels run laterally along the bodies of the lumbar vertebrae and divide into anterior and posterior branches at the medial border of the psoas muscle and anterior of the transverse process. Arrow shows the possible lumbar artery injury site.

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