Lumbar Plexus Palsy Caused by Massive Psoas Hematoma Related to Vertebral Compression Fracture in a Patient with Liver Cirrhosis

Osteoporotic vertebral compression fractures (VCFs) are common injuries in elderly patients and are usually stable because only the anterior column is involved. However, neurological deterioration may complicate osteoporotic VCFs, and most of them are related to canal invasion. Liver cirrhosis (LC) and its related complications have been identified as risk factors for an increased bleeding tendency, which, in turn, is associated with increased morbidity and mortality risks. We herein present a rare case of an osteoporotic VCF and a massive psoas hematoma that resulted in lumbar plexus palsy in a patient with LC after a stable-type spinal injury. To our knowledge, this is the first reported case of lumbar plexus palsy attributed to a liver-cirrhosis-related massive psoas hematoma and a stable VCF after minor trauma. This case highlights the potential risk of severe neurological deficits related to this type of common and seemingly trivial injury. The possible pathophysiological mechanisms are discussed and the relevant literature is reviewed.

Automated summary

Osteoporotic vertebral compression fractures (VCFs) are common and usually stable injuries in elderly patients, but they can lead to neurological deterioration due to canal invasion. Liver cirrhosis (LC) and its complications increase the risk of bleeding, which can contribute to increased morbidity and mortality. We present the first reported case of lumbar plexus palsy caused by a liver-cirrhosis-related massive psoas hematoma and a stable VCF after minor trauma. This case highlights the potential severe neurological deficits associated with seemingly trivial injuries and discusses possible pathophysiological mechanisms.