A misdiagnosed iliac pseudoaneurysm complicated lumbar disc surgery performed 13 years ago

Case report.

To describe a unique case of iliac pseudoaneurysm-complicated lumbar disc surgery performed 13 years ago.

Major vascular injury is an unusual but life-threatening complication of lumbar disc surgery. If a major vascular injury is unnoticed, the late complications, pseudoaneurysm, may be diagnosed years after primary lumbar disc surgery. Pseudoaneurysm can lead to compression of adjacent neurovascular structures; however, erosion into the adjacent vertebras and presentation with symptoms of nerve root irritation are rare.

The patient was a 54-year-old man who presented with pain and numbness in right hip and leg. Examination was normal. A plain radiograph showed destruction of the fourth and fifth lumbar vertebras. Magnetic resonance image showed a retroperitoneal mass eroding into the adjacent vertebras. The mass was primarily misdiagnosed as a neoplasm and a percutaneous needle biopsy was recommended. Before puncture, the computed tomographic angiogram confirmed it to be a pseudoaneurysm of left common iliac artery. Then, implantation of a covered stent was undergone.

After implantation of a covered stent, the symptoms were relieved immediately. At the 12-month follow-up, the patient remained asymptomatic, and a computed tomographic angiogram revealed progressive shrinkage of the mass and significant healing of the eroded vertebras.

As an unusual complication of lumbar disc surgery, iliac pseudoaneurysm can present with radiating pain even after 13 years and erode into the adjacent vertebras producing appearances mimicking a tumor. For mass located anterior to vertebras, the percutaneous biopsy must be cautiously performed, and a contrast-enhanced computed tomographic scan is necessary.