Post-traumatic retroperitoneal pseudomeningocele following lumbar spine injury: A case report

Background Post-traumatic retroperitoneal pseudomeningocele is an exceptionally rare complication of lumbar spine trauma. Delayed diagnosis may lead to cerebrospinal fluid (CSF) leakage, intracranial hypotension, subdural hematomas, and progressive spinal instability. Case description We report the case of a 21-year-old man involved in a high-speed motor vehicle accident who sustained multiple traumatic injuries associated with an initially overlooked L4–L5 ligamentous fracture-dislocation (AO type B1). Several months after the trauma, he developed a giant left retroperitoneal pseudomeningocele associated with orthostatic headaches due to intracranial hypotension. Magnetic resonance imaging and dynamic CT myelography demonstrated a large dural defect at the L4–L5 level with active CSF leakage. The patient underwent posterior surgical exploration with direct dural repair, multilayer sealing using hemostatic agents, and L4–L5 pedicle screw fixation. Postoperative recovery was uneventful, with resolution of the CSF collection and stabilization of the spinal lesion. Conclusions Retroperitoneal pseudomeningocele following lumbar trauma is rare and may occur after occult ligamentous injuries without major osseous fractures. Persistent CSF leakage should be suspected in patients presenting with delayed intracranial hypotension after spinal trauma. Early recognition, precise radiologic localization of the dural defect, and combined dural repair with spinal stabilization are essential to prevent neurological and systemic complications.