Description of injury to the sympathetic nervous system after the anterior approach to the lumbosacral spine remains restricted to reports of retrograde ejaculation in males occurring in 2% to 20% of patients. The authors describe a 46-year-old female who presented with low back pain for several years due to degenerative disk disease at L4-L5 that had been treated with an L4-L5 artificial disc replacement though a left anterior retroperitoneal approach. She has had an excellent outcome with complete resolution of her back pain, but noticed the development of dryness of her left lower limb with anhidrosis and skin breakdown, which has caused persistent discomfort. The complication had persisted at her 1-year follow up. Damage to the sympathetic system may often go unrecognized but present with subtle symptoms, as described in the present report. Sympathetic injury in women is often not addressed and remains unrecognized except for a few reports of vaginal dryness or anaesthesia. A short description of this unusual and underappreciated complication, which may be a cause of discomfort despite successful surgery, is presented.