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Journal of Korean Neurosurgical Society 2004;36(3): 246-248.
Retroperitoneal Hematoma Secondary to Terminal Branch of Segmental Artery Injury during Intertransverse Discectomy through Paramedian Muscle Splitting Approach.
Woo Jong Lee, Jong Pil Eun, Ha Young Choi, Jung Chung Lee
Department of Neurosurgery, Research Institute for Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea. jp-eun@hanmail.net
A 47-year-old man underwent the surgery of intertransverse discectomy through paramedian muscle splitting due to extraforaminal type of far lateral disc herniation at 4th-5th interspace of lumbar vertebrae. The authors encountered the terminal branch of the segmental artery that traversed the extruded disc around the dorsal root ganglion during the sugery. We coagulated the artery by a bipolar coagulator and cut the artery for the discectomy. There was no active bleeding during the surgery. However, the patient suffered from abdominal, right leg and flank pain at the first postoperative day. The follow-up magnetic resonance imaging revealed a retroperitoneal hematoma at the operation site. The patient underwent removal of the retroperitoneal hematoma. We identified the cause of bleeding as the rupture of coagulated terminal branch of the segmental artery around the dorsal root ganglion. The retroperitoneal hematoma was evacuated completely. The ruptured artery was clipped by a small metal clip, and his symptoms subsequently were resolved.
Key Words: Far lateral disc herniation; Paramedian muscle splitting approach; Retroperitoneal hematoma
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