Retroperitoneal lymphocele after lumbar total disc replacement: a case report and review of literature

Abstract

BackgroundRetroperitoneal lymphoceles (RPLs) caused by injury to the lymphatics are commonly seen after pelvic lymphadenectomy, renal transplantation, and gynecologic tumor resection surgeries. Degenerative disc disease still remains the major cause of low-back pain. Anterior lumbar spinal procedures, such as anterior lumbar interbody fusion and anterior lumbar arthroplasty, have been increasingly performed for treatment of axial back pain. RPLs, as an approach-related complication, though infrequent, have been reported after anterior lumbar spinal surgery. We report a case of RPL after total disc replacement of the lumbar spine. To our knowledge, there has been no prior report of RPL after total disc replacement managed by percutaneous aspiration only.MethodsA 49-year-old woman who underwent total disc replacement at the L4-5 level presented with a postoperative complication of RPL. The imaging findings, clinical course, and treatment are discussed, and a review of literature is presented.ResultsThe patient presented with significant abdominal swelling and discomfort at 4 weeks after surgery without any signs or symptoms of infection. Investigations showed an RPL. She was treated by multiple aspirations under ultrasound guidance. At 12 months’ follow-up, the patient had no further abdominal symptoms and had gone back to her routine activities and work with significant improvement in back pain.ConclusionsRPL is an uncommon complication after anterior lumbar surgery and can be managed effectively if detected and diagnosed early. Although repeated aspiration is associated with high recurrence and infection, it is a safe and minimally invasive procedure to manage RPL.

Abdominal Lymphocele Following Anterior Lumbar Interbody Fusion: A Case Report

“…An abdominal lymphocele is a rare complication of anterior lumbar interbody fusion [ 1 - 15 ]. Presentation depends on where the damage to the lymphatic system occurs.…”

“…On account of the anterior approach it has the potential for major complications such as vascular injury, visceral damage, ureteral damage, and retrograde ejaculation. An abdominal lymphocele is a rare complication associated with this procedure [ 1 - 14 ]. We report the presentation and management of a lymphocele after a multilevel ALIF procedure.…”

We Need to Talk about Lumbar Total Disc Replacement

“…The nonspinal complications of LTDR are classed as intraoperative (injury to ureter, nerves, 378 or large vessels 71,433 ) or postoperative (infection, 404 retrograde ejaculation, wound problems, hematoma, 71 formation of retroperitoneal lymphocele 401 ) and are common to all LTDR procedures that adopt an anterior lumbar surgical approach, irrespective of the LAD used. Although a less-invasive lateral approach 313,420 or a laparoscopic approach 430 for LTDR may impact the risk of the aforementioned and other complications, these innovations do not fulfill our a priori criteria for meaningful comment.…”