Lumbar artery rupture causing hemorrhagic shock after vertebroplasty in a nonagenarian: A case report.
Case Report
Percutaneous vertebroplasty (PVP) is an effective and minimally invasive treatment for osteoporotic vertebral compression fractures. Although generally safe, rare but life-threatening vascular complications may occur, particularly in frail elderly patients./r/nA 90-year-old woman with a history of chronic obstructive pulmonary disease, cardiac insufficiency, and type II respiratory failure presented with severe thoracolumbar pain refractory to conservative treatment./r/nImaging confirmed T10 and L1 osteoporotic compression fractures with severe osteoporosis (T-score - 4.5). Two hours after PVP, she developed nausea and diarrhea, followed by hypotension (73/40 mm Hg) and hemoglobin decline (Δ45 g/L). Computed tomography angiography confirmed retroperitoneal hematoma due to lumbar artery rupture./r/nThe patient underwent urgent superselective embolization via digital subtraction angiography and transfusion therapy, followed by intensive care monitoring./r/nHemostasis was successfully achieved. She was discharged on postoperative day 14, with recovery to baseline activities of daily living at the 3-month follow-up./r/nThis case highlights that fracture-induced displacement of lumbar arteries and transverse process hypoplasia increase vascular injury risk during PVP, atypical gastrointestinal symptoms may serve as early warning signs of retroperitoneal hemorrhage, and tailored preoperative vascular imaging and staged surgical strategies should be considered in frail patients undergoing multilevel PVP.
