Retroperitoneal hematoma following transforaminal percutaneous endoscopic lumbar discectomy: 3 cases reports and literature review
Wang Huafeng1, Zhou Fushan2, Wen Bingtao3, Liang Guiqing1, Wu Jianjun1
1Department of Spine Surgery, Fuzhou Second Hospital of Xiamen University, Fuzhou 350007, China; 2Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China; 3Department of Orthopedics, Peking University International Hospital, Beijing 102206, China
Abstract：Objective To present 3 cases of retroperitoneal hematoma (RPH) following transforaminal percutaneous endoscopic lumbar discectomy and to discuss how to prevent the complication of unintended hemorrhage by reviewing literatures.Methods The clinical data of 3 patiets admitted in 2 hospitals from March 2016 to January 2018 were retrospectively studied. The literatures about the RPH following transforaminal percutaneous endoscopic lumbar discectomy before July 2018 were searched in CNKI, Weipu, Wanfang and PubMed databases by using “percutaneous lumbar endoscopic discectomy” and “retroperitoneal hematoma” as key words. Seven cases reported in English and one case reported in Chinese were detected. The clinical and imaging features, prevention and treatment of the complication were observed and analyzed.Results All 3 cases were undertaken transforaminal percutaneous endoscopic lumbar discectomy under local anesthesia. The patient with hypovolemic shock was treated by lumbar vertebral segment arterial embolization. The case with progressive weakness of her right leg underwent open hematoma evacuation via posterior lumbar approach. The last case was treated conservatively. In 6-24 months follow-up, 2 cases recovered without any neurological or vascular sequelae, but 1 case presented residual neurological deficits. Eleven cases of RPH after percutaneous transforaminal lumbar discectomy were involved, including 3 cases in this paper and 8 cases reported in references. Most of them presented with pain and discomfort in the groin area after a short period of asymptomatic operation. Two cases of hypovolemic shock were treated with lumbar vertebral segment arterial embolization, two cases with diffuse hematoma (hematoma volume ≥500 mL) were treated with laparotomy hematoma removal, one case with progressive weakness of right leg underwent open hematoma evacuation via posterior lumbar approach, and the other 6 cases were treated conservatively. With proper treatments, overall prognosis was good.Conclusions RPH is an infrequent but serious complication of transforaminal percutaneous endoscopic lumbar discectomy. Adequate technical and anatomical considerations are important to avoid this unusual hemorrhagic complication. A high index of suspicion and early detection are also important to avoid the progression of the hematoma.
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2019, Vol. 24 
