Varicocele complicating an anterior lumbar interbody fusion: a case report

Anterior lumbar interbody fusion (ALIF) is performed for the surgical management of lumbar degenerative disc disease with excellent results, particularly for discogenic low back pain. Commonly reported complications associated with this approach include vessel injury, retrograde ejaculation, and ureteral and viscus organ injury. The development of a varicocele after ALIF has not been previously described in the literature. We report a case of varicocele in a 35-year-old patient who underwent ALIF via a left retroperitoneal approach. No intraoperative complications were identified. The postoperative course was uneventful. He was discharged from the hospital on the 5^th postoperative day. Three months after surgery, he complained of discomfort and scrotal pain. Examination revealed a grade 3 varicocele according to the Dubin and Amelar classification. Scrotal Doppler US demonstrated dilatation of the veins of the pampiniform plexus. A lumbar CT scan revealed a bulky left spermatic vein closed to the ureter. The patient was treated with platelet anti-aggregation. He was seen at control intervals of 1, 3 and 5 months. Progress was seen as we had a regression of clinical signs. Varicocele appears as an uncommon complication of ALIF. After reviewing the literature, we describe the occurrence of a varicocele following ALIF, its pathophysiology, and its treatment options.