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Chylous fistula: management of a rare complication following right anterior cervical spine approach

  • Federica NovegnoEmail author
  • Pierluigi Granaroli
  • Luigi Ciccoritti
  • Pierpaolo Lunardi
  • Mario Francesco Fraioli
Case Report

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Cervical spine Chyle leak Lymphatic ducts Discectomy Surgical complication 

Notes

Acknowledgements

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.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, Tor Vergata University Medical SchoolUniversity of Rome “Tor Vergata”RomeItaly
  2. 2.Department of Endocrine and Metabolic SurgeryFondazione Policlinico Universitario A. Gemelli, IRCCSRomeItaly

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