Intranodal Embolization of Lymphocele Following Anterior Lumbar Interbody Fusion: Case Report

Abstract

Postsurgical lymphocele is a rare complication following anterior lumbar interbody fusion (ALIF), for which ideal management remains controversial. Our study presents a case of a 70-year-old woman who underwent a multilevel anterior and posterior fusion from L3 to the pelvis with direct lateral interbody fusion at L3 to 4 and L4 to S1 ALIF and subsequently developed a persistent left-sided fluid collection, later identified as a retroperitoneal lymphocele. A temporary drainage catheter was initially placed within the collection but did not lead to complete resolution. Our case report presents a novel approach of using a diagnostic lymphangiogram to identify an active lymphatic leak for subsequent successful embolization of the source using n-butyl cyanoacrylate glue in dilution with lipiodol (1:8). Time to complete resolution was 12.5 weeks with 1 repeat aspiration but no additional glue embolization. We introduce lymphatic embolization as a robust alternative to operative management when treating post-ALIF lymphoceles, particularly in cases of high infection risk, or refractory disease.