Nowadays, anterior lumbosacral interbody fusion (ALIF) surgery is a predominant approach used in various indications, such as treating discogenic back pain, spondylolisthesis, degenerative lumbar scoliosis, or intervertebral foraminal stenosis [1]. It is particularly popular due to its multiple advantages: direct access to the spine without muscle dissection, reduced blood loss, decreased postoperative pain, and improved fusion rates [1], [2], [3], [4], [5], [6]. However, anterior approaches are associated with surgical complications, such as vascular injuries, retroperitoneal hematoma, or hypogastric plexus lesions [1], [2], [3], [4], [5], [6].

Migliorini et al. reported a case-series of urological complications after anterior approach to the spine[5]. The authors emphasized that, despite their rarity, spine surgeons should be more aware of their occurrence. Such injuries may be diagnosed in a delayed fashion after an anterolateral approach [4]. In this case, the authors report an uncommon presentation of a left ureteral iatrogenic injury diagnosed during the first postoperative week following ALIF surgery.