Delayed Presentation of a Symptomatic Psoas Hematoma Following Lumbar Vertebral Kyphoplasty for Myeloma: A Case Report

INTRODUCTION: The Royal National Orthopaedic Hospital (RNOH) is a tertiary referral center and patients with spinal complications from multiple myeloma are managed here in a multidisciplinary approach. Balloon kyphoplasty(BKP) procedures are routinely performed in such patients when clinically indicated with good results and a low complication rate. There are little data reported in the literature about post-BKP hematoma formation and its management. We present the first known reported case delayed post-operative psoas hematoma in a myeloma patient following a BKP. CASE REPORT: A 40-year-old male patient with diagnosed Ig G lambda multiple myeloma was referred to the spinal unit based at the RNOH. An L5 fracture was deemed to be the cause of significant lower back pain. He underwent an L5BKP with good immediate results and in the absence of any immediate complications. Post-operative, the patient had normal distal neurology and was discharged1day postoperatively. 3 days after surgery, he underwent left hamstrings anterior cruciate ligament reconstruction. 2 days following the latter, he developed significant pain in his left groin and thigh associated with numbness. A pelvicmagnetic resonance imaging scan confirmed a left iliopsoas hematoma. This case was treated conservatively under guidance of the multidisciplinary team. CONCLUSION: As psoas hematoma, formation is a rare complication following a BKP. The recommended management of a psoas hematoma is conservative with supportive therapy and regular clinical review. To reduce the risk of a psoas hematoma, the authors recommend that the trocar should be first placed on the transverse process and maneuvred medially to the start point on the pedicle. This would avoid injuries to the artery to the pars as well as structures deep to the intertransverse ligament avoiding this rare complication.