Retroperitoneal Hematoma Complicating Selective Nerve Root Block in a Patient with Low Back Pain

The patient was a 73-year-old woman. Final diagnosis: Lumbar spinal stenosis, lumbar disc herniation, retroperitoneal hematoma. Symptoms: Low back pain with radiating pain in the right lower limb; right lower abdominal pain. Clinical management: Selective nerve root block; emergency vascular interventional embolization for the complication of retroperitoneal hematoma after the operation. Background: This paper presents a clinical case of retroperitoneal hematoma following lumbar selective nerve root block. It describes the diagnostic and therapeutic management, along with associated imaging findings, and discusses strategies for preventing this complication. Case report: The patient was hospitalized due to chronic low back pain persisting for over two decades, which had recently worsened and was accompanied by radiating pain to the right lower limb for more than one month. Her medical history included hypertension, hyperlipidemia, diabetes mellitus, and coronary atherosclerosis. To identify the symptomatic level and alleviate her symptoms, a selective nerve root block was performed at the L4–L5 segment. Although the procedure provided temporary symptom relief, it was complicated by a secondary retroperitoneal hematoma. The hematoma was subsequently managed with emergency vascular interventional embolization, leading to successful control of the bleeding. Conclusion: For elderly patients with multiple comorbidities, careful preoperative evaluation is essential prior to performing a selective nerve root block. During the procedure, attention must be paid to the puncture angle and trajectory. In high-risk patients suspected of having abnormal vascular anatomy, preoperative abdominal computed tomography angiography (CTA) may be considered to minimize the risk of severe bleeding caused by puncture injury to aberrant or maldeveloped blood vessels