Chylous fistula: management of a rare complication following right anterior cervical spine approach
Chylorrhea resulting from injury of the lymphatic system during neck dissection is a well-known complication. It is an uncommon occurrence in spinal surgery, and only one case after right anterior cervical spine surgery has been described so far. Despite its rarity, chylous leakage deserves a particular attention since it may become a serious and occasionally fatal complication if not detected early and managed appropriately.
We report the case of a 42-year-old man who underwent a standard anterior cervical discectomy and fusion according to Cloward approach for a C6–C7 disk herniation. The patient developed a delayed prevertebral chyle collection on postoperative day 5, presenting with mild breathing and swallowing difficulties.
He was managed with conservative care, including bed rest, low-fat diet and drainage pouch positioning, which led to the complete resolution of the fluid collection.
Knowledge of the normal anatomy of the lymphatic system and of its variations is essential when planning an anterior spinal procedure, and represents the first measure to be adopted in order to avoid such complication. The prompt identification of a postoperative chylous fistula and the applicability of an individually based management’s protocol may help in the majority of the cases to reduce the potential morbidity, without significant long-term effects.
KeywordsCervical spine Chyle leak Lymphatic ducts Discectomy Surgical complication
We thank Dr. Elena Jane Mason for editing the manuscript.
Compliance with ethical standards
Conflict of interest
The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
- 10.Hilibrand AS, Nassr A, Arnold PM et al (2017) Epidemiology and outcomes of vertebral artery injury in 16 582 cervical spine surgery patients: an AOSpine North America Multicenter Study. Glob Spine J 7(1 Suppl):21S–27SGoogle Scholar
- 11.Hsu WK, Kannan A, Mai HT et al (2012) Chyloretroperitoneum following anterior spinal surgery. J Neurosurg Spine 17(5):415–421Google Scholar