Postoperative Retroperitoneal Hematoma following Percutaneous Lumbar Foraminoplasty

Percutaneous lumbar foraminoplasty is a widely used minimally invasive procedure for decompressing neural elements in patients with foraminal stenosis.Although generally considered safe, it can rarely cause life-threatening vascular complications.We present the case of a 72-year-old woman with chronic low back pain unresponsive to conservative treatment, who underwent foraminoplasty at bilateral L3-4, L4-5, and left L5-S1.One hour postoperatively, she developed left flank pain and hypotension.Abdominopelvic computed tomography revealed a large retroperitoneal hematoma in the left posterior pararenal space.Emergent angiography showed active arterial extravasation from branches of the left L4 lumbar artery and the iliolumbar artery, both of which were successfully embolized.This case illustrates a rare but potentially fatal complication of percutaneous lumbar foraminoplasty and underscores the importance of preprocedural imaging and meticulous trajectory planning to minimize such risks.