Location
Philadelphia, PA
Start Date
1-5-2024 1:00 PM
End Date
1-5-2024 4:00 PM
Description
Purpose:
This report highlights the uncommon presentation of postoperative recurrent calcified lumbar paraspinal hematoma. In doing so, we explore the details surrounding this phenomenon and describe the operative management utilized.
Background:
Paraspinal hematoma can be a common complication following spine surgery. However, most of these hematomas are asymptomatic and reabsorbed. There is a paucity of literature that describes the recurrence of these hematomas in a chronic setting and management when this situation is encountered. This case report describes a patient with a chronic recurrent calcified paraspinal hematoma that first developed over 4 years and then reoccurred 11 years later at the same site.
Case Description:
A 53-year-old female patient presented to our orthopedic team with severe lumbar back pain and right lower extremity radiculopathy. The patient subsequently underwent a lumbar decompression posterior spinal fusion from L3-S1 in 2008. Post-operatively, she developed a lumbar paraspinal hematoma. Initial treatment consisted of unsuccessful aspiration. Four years later, the patient sought treatment from a different neurosurgeon due to discomfort caused by a large lumbar mass. The mass was removed in 2012 with the assistance of plastic surgery for flap closure and was found to be a calcified hematoma. In November 2022, the patient sought treatment from her original orthopedic surgeon for a recurrence of the lumbar mass and radicular symptoms. An MRI of the lumbar spine confirmed the presence of a large mass within the paraspinal musculature. To alleviate her lumbar pain with associated radiculopathy, the surgeon recommended the removal of hardware L3-L5, revision laminectomy with posterior instrumentation from L2-L5, and removal of the lumbar mass. This procedure was successfully performed in February 2023. The pathology report classified the mass as a chronic calcified hematoma, which was 14 x 7 x 6.3 cm and weighed 299 grams. Postoperatively, the patient had complete relief from her symptoms. She continued follow-up with orthopedics and has remained free from the recurrence of the lumbar mass.
Conclusions:
This case demonstrates an extremely rare presentation not well described in the existing literature of a recurrent symptomatic calcified lumbar paraspinal hematoma that eventually required surgical treatment. While a rare occurrence, surgeons should be aware that recurrence is possible and can be managed by capsular excision.
Embargo Period
7-2-2024
Included in
Uncommon presentation of a chronic recurrent symptomatic encapsulated calcified post-operative paraspinal lumbar hematoma: A case report
Philadelphia, PA
Purpose:
This report highlights the uncommon presentation of postoperative recurrent calcified lumbar paraspinal hematoma. In doing so, we explore the details surrounding this phenomenon and describe the operative management utilized.
Background:
Paraspinal hematoma can be a common complication following spine surgery. However, most of these hematomas are asymptomatic and reabsorbed. There is a paucity of literature that describes the recurrence of these hematomas in a chronic setting and management when this situation is encountered. This case report describes a patient with a chronic recurrent calcified paraspinal hematoma that first developed over 4 years and then reoccurred 11 years later at the same site.
Case Description:
A 53-year-old female patient presented to our orthopedic team with severe lumbar back pain and right lower extremity radiculopathy. The patient subsequently underwent a lumbar decompression posterior spinal fusion from L3-S1 in 2008. Post-operatively, she developed a lumbar paraspinal hematoma. Initial treatment consisted of unsuccessful aspiration. Four years later, the patient sought treatment from a different neurosurgeon due to discomfort caused by a large lumbar mass. The mass was removed in 2012 with the assistance of plastic surgery for flap closure and was found to be a calcified hematoma. In November 2022, the patient sought treatment from her original orthopedic surgeon for a recurrence of the lumbar mass and radicular symptoms. An MRI of the lumbar spine confirmed the presence of a large mass within the paraspinal musculature. To alleviate her lumbar pain with associated radiculopathy, the surgeon recommended the removal of hardware L3-L5, revision laminectomy with posterior instrumentation from L2-L5, and removal of the lumbar mass. This procedure was successfully performed in February 2023. The pathology report classified the mass as a chronic calcified hematoma, which was 14 x 7 x 6.3 cm and weighed 299 grams. Postoperatively, the patient had complete relief from her symptoms. She continued follow-up with orthopedics and has remained free from the recurrence of the lumbar mass.
Conclusions:
This case demonstrates an extremely rare presentation not well described in the existing literature of a recurrent symptomatic calcified lumbar paraspinal hematoma that eventually required surgical treatment. While a rare occurrence, surgeons should be aware that recurrence is possible and can be managed by capsular excision.
Comments
Presented by Antonio Almeda-Lopez.