Retroperitoneal Hemorrhage After Percutaneous Posterior Spinal Instrumentation: A Case Report

Retroperitoneal hemorrhages are an uncommon but potentially fatal complication in the setting of recent spine surgery. Patients generally report lower abdominal or groin pain, and they may demonstrate signs of hemodynamic instability. Prompt recognition of retroperitoneal hemorrhages requires a thorough history and physical examination, monitoring of appropriate laboratory values, and often advanced imaging. Whereas treatment can occasionally be achieved with conservative measures, retroperitoneal hemorrhage is most commonly treated with embolization. We present a case of spontaneous retroperitoneal hemorrhage after percutaneous L3 to pelvis posterior spinal instrumentation and L4-L5 posterolateral fusion with allograft. In our case, the patient was noted to be hypotensive and began reporting right lower quadrant abdominal pain on postoperative Day 2. Investigation with computed tomography angiography revealed a right retroperitoneal hematoma with small areas of active bleeding, ultimately requiring an embolization procedure with interventional radiology. The patient was last seen for a 1-year follow-up, at which time he demonstrated 5/5 motor strength and fully intact sensation throughout L2-S1 of the bilateral lower extremities. He complained of mild right lumbar pain over the region of hardware after recently losing approximately 30 pounds and recent balance issues. This case highlights common presenting signs/symptoms of a relatively uncommon and potentially fatal complication in the setting of percutaneous spinal surgery; we hope to increase awareness and improve prompt recognition among providers to help minimize serious complications for patients.