title: Retroperitoneal lymphocele after lumbar total disc replacement: a case report and review of literature.
abstract: BACKGROUND
  Retroperitoneal 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  RPL 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.
authors: Spine Service, Department of Orthopaedic Surgery, St. George Hospital and Clinical School, University of New South Wales, Kogarah, Australia.
authors: Bibhudendu
authors: B
authors: Mohapatra
authors: Spine Service, Department of Orthopaedic Surgery, St. George Hospital and Clinical School, University of New South Wales, Kogarah, Australia.
authors: Thomas
authors: T
authors: Kishen
authors: Department of Upper GI and Bariatric Surgery, St. George Private Hospital, Kogarah, Australia.
authors: Ken W K
authors: KW
authors: Loi
authors: Spine Service, Department of Orthopaedic Surgery, St. George Hospital and Clinical School, University of New South Wales, Kogarah, Australia.
authors: Ashish D
authors: AD
authors: Diwan
keywords: Anterior lumbar spine surgery; Degenerative disc disease; Retroperitoneal lymphocele; Total disc replacement