Intramuscular Pseudoaneurysm Following Minimally Invasive Pedicle Screw Fixation for Lumbar Fracture Treated With Thrombin Injection: A Report of a Rare Case

TL;DR

A rare case of an intramuscular pseudoaneurysm after minimally invasive spine surgery was successfully treated with thrombin injection.

Contribution

Demonstrates the effectiveness of fluoroscopy-guided thrombin injection for treating postoperative pseudoaneurysms in ankylosing spondylitis patients.

Findings

A 66-year-old patient with ankylosing spondylitis developed a pseudoaneurysm after MIS pedicle screw fixation.

Fluoroscopy-guided thrombin injection successfully treated the pseudoaneurysm with no recurrence at follow-up.

The case highlights the importance of considering vascular injury in postoperative ankylosing spondylitis patients.

Abstract

Minimally invasive surgery (MIS) techniques offer reduced tissue disruption and faster recovery, but rare vascular complications such as pseudoaneurysm may still occur. We present the case of a 66-year-old female patient with ankylosing spondylitis who sustained an unstable L2 fracture. Following navigated MIS pedicle screw fixation, she developed delayed paraspinal swelling. Initial CT demonstrated a paraspinal hematoma, and subsequent CT angiography confirmed an intramuscular pseudoaneurysm, which was successfully treated with fluoroscopy-guided thrombin injection. The patient remained asymptomatic with no recurrence at six-week and five-month follow‑up. This case underscores the importance of maintaining a high index of suspicion for vascular injury in postoperative patients with ankylosing spondylitis and demonstrates the effectiveness of fluoroscopy‑guided thrombin injection as a minimally invasive treatment option, contextualized by a brief literature review of diagnostic challenges and evolving management strategies.

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