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Pre-operative Anterioposterior (A) and Lateral (B) X-ray of lumbar spine.
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Pre-operative X-rays during this presentation showing significant instability and degenerative scoliosis is demonstrated in (Figure 1).
Pre-operative MRI of lumbar spine. (A) sagittal, (B) axial Level L4-L5.
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MRI entire spine showed multilevel degenerative disc disease with L1-L2 and L2-L3 dorsal complex of disc protrusion and osteophytes, L3-L4 interval progression with secondary spinal stenosis, L4-L5 reduced spinal stenosis compared to previous images (Figure 2).
Post-operative Anterioposterior (A) and Lateral (B) X-rays of lumbar spine.
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Underwent XLIF technique at L3-L4, L4-L5 and then 2nd stage with posterior L3-L5 fusion with pedicle screws with standard surgical steps without any complications (Figure 3).
Post-operative CT scan showing psoas hematoma (A). Follow-up CT scan at 4 months showing complete resolution of psoas hematoma (B).
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An abdominal CT scan was obtained, showing large left-sided retroperitoneal hematoma measuring about 8.3 x 8.5 x 17 cm in AP, transverse, and craniocaudal diameter respectively, inseparable from the left iliopsoas muscle (Figure 4). Plasma (FFP) and 2 units of platelets done for the patient. Patient was stable afterwards, and was on close observation. Conservative management was undertaken, with follow-up CT scan showing no progression. Patient was discharged few days later in stable condition with symptoms and signs of femoral nerve palsy; follow-up CT scans revealed resolution of the hematoma (Figure 4).