Large Retroperitoneal Hematoma and Lumbosacral Plexopathy Following Microsurgical Decompression via the Wiltse Paraspinal Approach: A Case Report

Paraspinal approaches are associated with fewer complications and better outcomes than midline approaches. However, most surgeons are not conversant with the surgical anatomy in these approaches, especially at the lumbosacral junction, where the anatomy is more complex. This paper reports a case of concomitant vascular and neurological complication following the use of the microscopic Wiltse approach. A 71-year-old woman presented with symptoms of spinal stenosis and right L5 radiculopathy. She underwent microsurgical decompression of a foraminal stenosis at the lumbosacral junction via the Wiltse approach, and a midline decompression from L3 to L5. The tubular retractor was docked inappropriately, being too deep and lateral. It directly punctured through the intertransverse membrane and injured the retroperitoneal segmental vessel and lumbosacral plexus. Postoperatively, she developed a large retroperitoneal hematoma and lumbosacral plexopathy, which were treated with surgery and intensive rehabilitation. This report highlights the importance of accurate retractor docking, familiarity with the surgical anatomy, and recognition of the potential complications of this technique.

Abstract licence: CC BY-NC

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