Unveiling rare complications after Anterior Lumbar Interbody Fusion (ALIF): A comprehensive analysis of fluid collections and surgical risks

Author(s): Lima João Vitor Fernandes, Onishi Jooji Franz, Vasconcelos Vladimir Tonello, Cavalheiro Sergio

Objective: To investigate the diagnosis and management of retroperitoneal fluid collections following anterior lumbar interbody fusion (ALIF), focusing on their presentation, diagnostic timelines, and therapeutic approaches through a systematic review of existing literature.

Methods: A comprehensive review was conducted to synthesize data on the incidence, diagnosis, and management of retroperitoneal fluid collections post-ALIF. Key parameters assessed included types of collections, average time to diagnosis, imaging modalities used, and treatment strategies. Statistical analysis was applied to determine significant differences in presentation and management outcomes.

Results: The analysis of 23 studies revealed that the most commonly observed retroperitoneal fluid collections following ALIF were lymphoceles, hematomas, and urinomas. Lymphoceles exhibited a statistically larger mean volume (1.3 L) than urinomas (0.6 L), with an overall mean collection volume of 770 ml across all cases. Regarding diagnostic timelines, lymphoceles had an average time to diagnosis of 10 days, whereas urinomas were identified sooner, with an average of 3.5 days. Notably, some cases of infected lymphocele were documented as late as five years postoperatively, and chyloperitoneum as late as 206 days post-surgery. Computed tomography (CT) emerged as the most frequently utilized diagnostic modality, employed in 16 of the 23 studies, underscoring its role as the primary method for detecting these collections.

Conclusion: Retroperitoneal collections following ALIF present a significant diagnostic and management challenge, requiring timely identification and intervention. CT imaging is the primary diagnostic tool, with varying management strategies based on collection type and severity. This review underscores the importance of early diagnosis and a multidisciplinary approach to optimizing patient outcomes.