Retroperitoneal Hematoma Following Lumbar Injection in a Patient Receiving Clopidogrel: A Case Report

Area of Science:

• Pain Management
• Interventional Radiology
• Neurology

Background:

• Lumbar spine injections are common for pain management.
• Hemorrhagic complications are rare but serious, particularly with antiplatelet therapy.
• Deep lumbar procedures increase bleeding risk.

Purpose of the Study:

• To report a case of retroperitoneal hematoma and neurologic injury after lumbar injections in a patient on clopidogrel.
• To highlight the risks of combining multiple deep lumbar procedures.
• To emphasize the need for risk assessment in patients on antiplatelet therapy.

Main Methods:

• Case report of a 56-year-old male on clopidogrel.
• Patient underwent a lumbar medial branch block and a psoas compartment block.
• Diagnosis of retroperitoneal hematoma confirmed by angiography; treated with embolization.
• Neurologic injury assessed via electrodiagnostic studies.

Main Results:

• The patient developed a significant retroperitoneal hematoma requiring embolization.
• The patient experienced persistent left lower extremity weakness and sensory deficits (upper lumbar plexopathy).
• The outcome suggests a link between combined deep lumbar injections and severe complications.

Conclusions:

• Combining high-bleeding-risk lumbar procedures under uninterrupted antiplatelet therapy (clopidogrel) can cause severe hemorrhage and neurologic sequelae.
• Procedure-specific risk stratification and cumulative bleeding risk assessment are crucial.
• Long-term electrophysiological monitoring is recommended for patients undergoing lumbar injections while on antiplatelet therapy.