CASE REPORT - SPINE DEGENERATIVE Pseudoaneurysm of a segmental lumbar artery following a full-endoscopic transforaminal lumbar discectomy: a rare approach-related complication Konstantinos Panagiotopoulos 1 & Roberto Gazzeri 1 & Antonio Bruni 2 & Umberto Agrillo 1 Received: 13 November 2018 /Accepted: 8 March 2019 # Springer-Verlag GmbH Austria, part of Springer Nature 2019 Abstract Full-endoscopic transforaminal lumbar discectomy is based on a puncture technique using a guide needle to reach the target area of the foramen via a percutaneous posterolateral/lateral approach. It may correlate with specific approach-related complications, as exiting nerve root injury. We report the first case of pseudoaneurysm of the lumbar segmental artery secondary to a transforaminal full-endoscopic surgery in the treatment of a lumbar herniated disc. A 39-year-old man underwent left L4-L5 full-endoscopic transforaminal lumbar discectomy for a herniated disc. Three hours after surgery, he experienced acute progres- sive abdominal pain. An abdomen CT scan showed contrast extravasation in the left paraspinal compartment at L4 vertebral body level. The selective left lumbar angiogram revealed a pseudoaneurysm of a side branch of the left lumbar segmental artery, which was treated by endovascular coiling. The patient made a rapid postoperative recovery without further complications and was discharged 4 days later. This report identifies a rare complication of transforaminal full-endoscopic surgery in the treatment of a herniated lumbar disc. To our knowledge this is the first case of pseudoaneurysm formation of the lumbar artery following a full- endoscopic transforaminal lumbar discectomy. Keywords Full-endoscopic lumbar discectomy . Percutaneous . Transforaminal approach . Vascular injury . Lumbar pseudoaneurysm Introduction In recent years, the full-endoscopic transforaminal lumbar discectomy (FETD) has been considered as a safe and effec- tive alternative to standard microsurgical procedures for the treatment of lumbar herniated discs and other disorders [3, 11, 14 , 20 ]. FETD differs significantly from traditional microdiscectomy as it is a pure percutaneous posterior- lateral or lateral approach to the foraminal area and it is related to a steep learning curve [9, 16]. The latter mainly correlates with the blind puncture technique which distinguishes the ini- tial phase of the procedure and thus with the specific approach-related complications including exiting nerve root injury or visceral injury [1, 5, 10–12]. We report the occurrence of a pseudoaneurysm of a seg- mental lumbar artery secondary to a full-endoscopic transforaminal L4-L5 discectomy procedure, and we discuss the mechanism of such a rare approach-related complication. Case report A 39-year-old man presented with 3-month history of left leg pain, refractory to conservative treatment. Lumbar spine mag- netic resonance imaging (MRI) demonstrated a left paramedian extruded herniated disc at L4-L5 level. A left L4-L5 FETD was performed, according to the technique de- scribed by Ruetten et al. [15]. This article is part of the Topical Collection on Spine degenerative * Roberto Gazzeri robertogazzeri@gmail.com 1 Department of Neurosurgery, San Giovanni Addolorata Hospital, Via Amba Aradam 9, 00184 Rome, Italy 2 Department of Radiology, San Giovanni Addolorata Hospital, Rome, Italy Acta Neurochirurgica https://doi.org/10.1007/s00701-019-03876-7