Iliopsoas hematoma with femoral neuropathy presenting a diagnostic dilemma after spinal decompression.
METHODS
Case report of an iliopsoas hematoma with femoral neuropathy appearing 8 weeks after a posterior spinal decompression procedure.


OBJECTIVE
To describe a potential complication and differential diagnosis for nerve root symptoms following spinal decompression.


BACKGROUND
Iliopsoas hematoma is usually a complication of anticoagulation, hemophilia, or trauma. It has not been described previously as a complication of posterior spinal decompression. Femoral neuropathy results from compression within the iliopsoas compartment.


METHODS
A 53-year-old woman reported pain in the right side of her groin and an increasing fixed flexion deformity of the right hip 8 weeks after a posterior, midline, spinal decompression. A femoral neuropathy later developed. Magnetic resonance imaging and computed tomography were performed.


RESULTS
Imaging studies demonstrated a diffusely enlarged iliopsoas. Exploration revealed a large hematoma, which was evacuated. The compartment was fully decompressed with resolution of the nerve root symptoms within 48 hours.


CONCLUSIONS
Iliopsoas pathology is a rare cause of nerve root symptoms and presented diagnostic difficulties after an apparently successful spinal decompression.
Department of Orthopaedics, Taunton and Somerset Hospital, Musgrove Park, Taunton, England. drobinsonfrcs@hotmail.com
D E
DE
Robinson
K E
KE
Ball
P J
PJ
Webb
D003161:Compartment Syndromes / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D019299:Decompression, Surgical / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D005267:Femoral Nerve / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007796:Laminectomy / Q000009:adverse effects; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D016658:Psoas Muscles / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D013130:Spinal Stenosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D013131:Spine / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome