Patel Alpesh A, Spiker William R, Daubs Michael D, Brodke Darrel S, Cheng Ivan, Glasgow Robert E
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT 84108, USA.
Spine (Phila Pa 1976). 2008 Aug 15;33(18):E648-52. doi: 10.1097/BRS.0b013e31817c6ced.
Case report; Review of Literature.
To present an uncommon complication after anterior lumbar surgery as well as a treatment option and a review of the literature.
A number of complications have been reported after anterior lumbar surgery. Common complications include vascular, ureteral, and neurologic injuries. The development of a retroperitoneal lymphocele has been previously been described, but details regarding evaluation, diagnosis, and treatment options are lacking in the literature.
The case of a single patient with a postoperative retroperitoneal lymphocele was identified and retrospectively reviewed. Permission was obtained from the patient to review and publish this information. A review of literature on lymphoceles and anterior lumbar complications was also performed using PubMed and Ovid databases.
A 76-year-old woman underwent anterior interbody fusion from L2-L3-L4-L5, followed by posterior T11-L5 fusion for degenerative scoliosis and spinal stenosis. Six weeks after surgery, she presented with severe abdominal pain, nausea, and emesis. Examination revealed a retroperitoneal lymphocele, which was confirmed after aspiration. The patient was treated with a laparoscopic marsupialization procedure without recurrence. At 12 months, the patient had no further abdominal symptoms, noted improvements in back and leg pain scores, and had stable radiographic findings.
Retroperitoneal lymphocele is a rare complication after anterior lumbar interbody fusion. The different diagnosis should include infectious abscess, ureteral injury with urinoma, pancreatic injury with pseudocyst formation, and spinal fluid leak with pseudomeningocele. Diagnosis can be guided by serum and cyst fluid analysis. Although treatment options exist, surgical treatment may provide the most reliable results.
病例报告；文献综述。
介绍腰椎前路手术后一种罕见的并发症、一种治疗选择并进行文献综述。
已有多项关于腰椎前路手术后并发症的报道。常见并发症包括血管、输尿管和神经损伤。此前曾有腹膜后淋巴管瘤形成的描述，但文献中缺乏关于评估、诊断和治疗选择的详细信息。
确定并回顾了一名术后发生腹膜后淋巴管瘤患者的病例。已获得患者许可以回顾和发表此信息。还使用PubMed和Ovid数据库对有关淋巴管瘤和腰椎前路并发症的文献进行了综述。
一名76岁女性接受了L2 - L3 - L4 - L5前路椎间融合术，随后因退行性脊柱侧弯和椎管狭窄接受了T11 - L5后路融合术。术后六周，她出现严重腹痛、恶心和呕吐。检查发现腹膜后淋巴管瘤，抽吸后得以证实。该患者接受了腹腔镜袋形缝合术治疗，未复发。12个月时，患者无进一步腹部症状，背部和腿部疼痛评分有所改善，影像学检查结果稳定。
腹膜后淋巴管瘤是腰椎前路椎间融合术后罕见的并发症。鉴别诊断应包括感染性脓肿、输尿管损伤伴尿瘤、胰腺损伤伴假性囊肿形成以及脑脊液漏伴假性脑脊膜膨出。诊断可通过血清和囊液分析来指导。虽然存在多种治疗选择，但手术治疗可能提供最可靠的结果。
