Chylous fistula during anterior cervical microdiscectomy: Case report and literature review

The anterior approach to the cervical spine is a widely used technique in spinal surgery. Although its most common complications involve vascular, neural, or digestive structures, there is also the potential for injury to lymphatic vessels, which can lead to serious complications if not promptly diagnosed and treated. We present the case of a 70-year-old woman with a history of lumbar arthrodesis and a C5-C6 cervical prosthesis, who underwent an anterior microdiscectomy at C7-T1 via a right-sided approach. During dissection, a dense whitish fluid compatible with chyle was observed, indicating injury to a lymphatic vessel. Ligation with suture was performed and a prevertebral drain was placed. In the postoperative period, the patient developed a mild hematoma in the acromioclavicular region, without cervical collections. The drain was removed after four days of total fasting, followed by the introduction of a low-fat diet. The patient was discharged without complications. After five years of follow-up, no associated complications have been observed. Chyle fistula following anterior cervical discectomy is a rare complication (0.02%) and should be suspected in the presence of milky fluid in the surgical wound, drainage, and/or progressive accumulation. Early diagnosis and appropriate treatment are essential to prevent more severe outcomes. The risk is higher in left-sided approaches near C6 and low right-sided approaches (C7-T1), particularly in the presence of anatomical variants.