Thoracic and retroperitoneal lymphatic injuries following spine surgery: illustrative cases

Postoperative lymphatic leakage is a rare complication of spine surgery caused by injury to the thoracic duct, cisterna chyli, or retroperitoneal lymphatic channels. Because of its rarity, diagnosis is often delayed and optimal management remains poorly defined. The authors present 3 illustrative cases and review current diagnostic and therapeutic strategies.

A 66-year-old man developed a right chylothorax after posterior T2-3 corpectomy with costotransversectomy and cervicothoracic fusion for metastatic spinal cord compression. Following failed thoracic duct embolization, he underwent thoracoscopic ligation and talc pleurodesis with complete resolution. A 75-year-old man developed a retroperitoneal lymphatic leak after an aborted oblique lumbar interbody fusion (OLIF), which resolved with percutaneous drainage and dietary modification. A 70-year-old woman developed a symptomatic retroperitoneal lymphatic leak after staged multilevel OLIF and posterior deformity correction. Intranodal lymphangiography localized the leak and enabled successful embolization with n-butyl cyanoacrylate, avoiding reoperation.

Lymphatic injury after spine surgery is uncommon but may occur after both thoracic and retroperitoneal approaches. Early recognition, biochemical confirmation, and multidisciplinary management are essential. Lymphangiography is central to diagnosis and treatment, although refractory cases may require surgery. Awareness of these complications may improve patient outcomes. https://thejns.org/doi/10.3171/CASE26792.