In spine sugery, iatrogenic vascular injury is unusual, and most common vascular injury is said to be a tear of the left common iliac artery. We report a case of retroperitoneal hematoma from lumbar segmental artery injury after posterior lumbar fusion and pedicle screw fixation. This 60-year-old woman presented with 6 months history of low back pain and radiating pain to the left lower leg. She complained of claudication after 10 meters walking due to spondylolisthesis and spinal stenosis at L2-L5 level. She underwent multiple total laminectomy, posterior lumbar interbody fusion, and transpedicular screw at L2-L5. During operation there was not evidence of complications such as bleeding. She complained of abdominal pain on post-operation 1 day and showed tenderness on left upper quadrant. Hemoglobin was 8.4 g/dL on postoperative laboratory examination. Abdominal CT scan revealed retroperitoneal hematoma. We performed angiography for evaluation of hematoma and found extravasation of dye at segmental artery of L4 level. We embolized the bleeding artery with coil successfully. Her postoperative abdominal pain and tenderness were relieved after then and discharged without pain or neurological deficit.
