title: Delayed lymphocele formation following lateral lumbar interbody fusion of the spine.
abstract: This paper aims to describe the rare post-operative complication of a lymphocele formation after lateral lumbar interbody fusion.
  
  
  
  The patient in this case was a 76-year-old lady with a 10 year history of low back pain and neurogenic claudication. She had previously underwent multiple spine surgeries for her condition. She presented to our institution for a recurrence of her low back pain and right anterior thigh pain. She then underwent surgery in two stages; first, a mini-open lateral interbody fusion at L3/4 and L4/5; second, posterior instrumentation of T3 to S1 with sagittal spinal deformity correction.
  
  
  
  The patient recovered uneventfully in the initial post op period and was discharged within 8 days. However, she developed abdominal distension and discomfort 6 months after surgery. MRI and CT scan of her abdomen showed a retroperitoneal fluid collection compressing her left ureter, resulting in hydroureter and hydronephrosis. She was managed with a CT-guided drainage of the fluid collection. Fluid analysis was consistent with a lymphocele. Since the procedure, the patient has been asymptomatic for 2 years.
  
  
  
  Delayed lymphocele formation is a potential complication of lateral lumbar interbody fusion. When present, it can be managed conservatively with good results. This case suggests that surgeons should have a low threshold to investigate for a lymphocele development post-anterior or lateral lumbar spine surgery. The authors recommend the placement of a post surgical retroperitoneal drain, as it might assist in the early detection of a lymphocele formation.
authors.affiliation: University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore. dennis_hey@nuhs.edu.sg.
authors.forename: Hwee Weng Dennis
authors.identifier: 0000-0003-1506-8553
authors.initials: HWD
authors.lastname: Hey
authors.affiliation: University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore.
authors.forename: Keng Lin
authors.initials: KL
authors.lastname: Wong
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Ciptomangunkusumo National General Hospital, Jakarta, Indonesia.
authors.forename: Asrafi Rizki
authors.initials: AR
authors.lastname: Gatam
authors.affiliation: University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore.
authors.forename: Joel Louis
authors.initials: JL
authors.lastname: Lim
authors.affiliation: University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore.
authors.forename: Hee-Kit
authors.initials: HK
authors.lastname: Wong
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008210:Lymphocele / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology; D012187:Retroperitoneal Space / Q000473:pathology; D013121:Spinal Curvatures / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*
keywords: Complication; Hydronephrosis; Lateral lumbar interbody fusion; Lymphocele; Revision surgery