Lumbar artery rupture causing hemorrhagic shock after vertebroplasty in a nonagenarian: A case report
Shengrong Xie1, Yan Wang2, Yingchun Dong1
1Department of Orthopaedics, West China Longquan Hospital Sichuan University, Chengdu, China.
Rationale:
Percutaneous vertebroplasty (PVP) is an effective and minimally invasive treatment for osteoporotic vertebral compression fractures. Although generally safe, rare but life-threatening vascular complications may occur, particularly in frail elderly patients.
Patient Concerns:
A 90-year-old woman with a history of chronic obstructive pulmonary disease, cardiac insufficiency, and type II respiratory failure presented with severe thoracolumbar pain refractory to conservative treatment.
Diagnoses:
Imaging confirmed T10 and L1 osteoporotic compression fractures with severe osteoporosis (T-score - 4.5). Two hours after PVP, she developed nausea and diarrhea, followed by hypotension (73/40 mm Hg) and hemoglobin decline (Δ45 g/L). Computed tomography angiography confirmed retroperitoneal hematoma due to lumbar artery rupture.
Interventions:
The patient underwent urgent superselective embolization via digital subtraction angiography and transfusion therapy, followed by intensive care monitoring.
Outcomes:
Hemostasis was successfully achieved. She was discharged on postoperative day 14, with recovery to baseline activities of daily living at the 3-month follow-up.
Lessons:
This case highlights that fracture-induced displacement of lumbar arteries and transverse process hypoplasia increase vascular injury risk during PVP, atypical gastrointestinal symptoms may serve as early warning signs of retroperitoneal hemorrhage, and tailored preoperative vascular imaging and staged surgical strategies should be considered in frail patients undergoing multilevel PVP.
