Chyluria and Chylothorax After Posterior Selective Fusion for Adolescent Idiopathic Scoliosis

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2017 May 6

PMID 28474285

Citations 5

Authors

Alexander A Weening

Bernadette Schurink

Jelle P Ruurda

Richard van Hillegersberg

Ronald L A W Bleys

Moyo C Kruyt

Affiliations

Soon will be listed here.

Abstract

Purpose: To describe and discuss the diagnostic and treatment complexity of lymphatic system complications after scoliosis surgery.

Methods: Surgery for adolescent idiopathic scoliosis is very commonly performed with posterior pedicle screw instrumentation. Complications of the anteriorly based lymphatic system are, therefore, rare. We present a case with complications related to the lymphatic system, which have not been reported before after this type of surgery.

Results: After standard Th3 to Th12 posterior spinal reduction and fusion of a moderate thoracic curve, chyluria and a chylothorax developed in an adolescent girl. This appeared to be caused by an obstruction of the thoracic duct. Thorax drainage and finally thoracoscopic intervention prevented further pulmonal impairment. The exact cause could not be identified and the persistent lymph drainage problems had to be treated with a medium chain triglyceride diet.

Conclusion: With this report, we aim to create awareness of the lymphatic system in general and the possibility of severe complications, even after a posterior only approach of the vertebral column.

Citing Articles

Postoperative left-sided chylothorax following posterior approach in late-onset idiopathic scoliosis surgery.

Van-Loo J, Adsul N, Loughenbury P, Gummerson N Surg Neurol Int. 2024; 15:408.

PMID: 39640324 PMC: 11618776. DOI: 10.25259/SNI_823_2024.

Renal pedicle lymphatic ligation for non-parasitic chyluria via retroperitoneal laparoscopic surgery: a single-center 12-year experience.

Wang K, Li B, Zhu Z, Zhang L, Liu Z, Huang L Transl Androl Urol. 2023; 12(10):1511-1517.

PMID: 37969770 PMC: 10643388. DOI: 10.21037/tau-23-287.

Chylothorax after spinal fusion surgery: A case report and literature review.

Toriyama K, Kokuho N, Yajima C, Kawagoe J, Togashi Y, Tsuji T Respir Med Case Rep. 2019; 26:260-264.

PMID: 30815356 PMC: 6378334. DOI: 10.1016/j.rmcr.2019.02.004.

Expert's Comment concerning Grand Rounds case entitled "Chyluria and chylothorax after posterior selective fusion for adolescent idiopathic scoliosis" by A.A. Weening et al. Eur Spine J; DOI 10.1007/s00586-017-5066-y.

Majewski A Eur Spine J. 2018; 27(9):2093-2094.

PMID: 29948323 DOI: 10.1007/s00586-018-5621-1.

Chyluria in non-filarial endemic areas: an internist's perspective.

Tan Y BMJ Case Rep. 2017; 2017.

PMID: 28978586 PMC: 5652487. DOI: 10.1136/bcr-2017-220772.

References

Selle J, Snyder 3rd W, SCHREIBER J . Chylothorax: indications for surgery. Ann Surg. 1973; 177(2):245-9. PMC: 1355573. DOI: 10.1097/00000658-197302000-00022. View

de Almeida A, Freedman D . Epidemiology and immunopathology of bancroftian filariasis. Microbes Infect. 2000; 1(12):1015-22. DOI: 10.1016/s1286-4579(99)80519-x. View

Phang K, Bowman M, Phillips A, Windsor J . Review of thoracic duct anatomical variations and clinical implications. Clin Anat. 2013; 27(4):637-44. DOI: 10.1002/ca.22337. View

KRAUS G, Bucholz R, Weber T . Spinal cord arteriovenous malformation with an associated lymphatic anomaly. Case report. J Neurosurg. 1990; 73(5):768-73. DOI: 10.3171/jns.1990.73.5.0768. View

Lameer C . [The development of chylothorax in obstruction of the thoracic duct]. Ned Tijdschr Geneeskd. 1966; 110(34):1493-5. View

Schulman A, Fataar S, Dalrymple R, Tidbury I . The lymphographic anatomy of chylothorax. Br J Radiol. 1978; 51(606):420-7. DOI: 10.1259/0007-1285-51-606-420. View

Chinnock B . Chylothorax: case report and review of the literature. J Emerg Med. 2003; 24(3):259-62. DOI: 10.1016/s0736-4679(02)00751-5. View

Adler R, LEVINSKY L . Persistent chylothorax. Treatment by talc pleurodesis. J Thorac Cardiovasc Surg. 1978; 76(6):859-64. View

Diamond E, SCHAPIRA H . Chyluria--a review of the literature. Urology. 1985; 26(5):427-31. DOI: 10.1016/0090-4295(85)90147-5. View

10.

Chen E, Itkin M . Thoracic duct embolization for chylous leaks. Semin Intervent Radiol. 2012; 28(1):63-74. PMC: 3140251. DOI: 10.1055/s-0031-1273941. View

11.

Panchal V, Chen R, Ghahremani G . Non-tropical chyluria: CT diagnosis. Abdom Imaging. 2011; 37(3):494-500. DOI: 10.1007/s00261-011-9782-1. View

12.

DJINDJIAN R, Hurth M, Houdart R . [Spinal angiomas, segmentary vascular dysplasia and phacomatosis]. Rev Neurol (Paris). 1971; 124(2):121-42. View

13.

Cheng J, Mohan S, Nasr S, DAgati V . Chyluria presenting as milky urine and nephrotic-range proteinuria. Kidney Int. 2006; 70(8):1518-22. DOI: 10.1038/sj.ki.5001703. View

14.

Dumont A, MAYER D, MULHOLLAND J . THE SUPPRESSION OF IMMUNOLOGIC ACTIVITY BY DIVERSION OF THORACIC DUCT LYMPH. Ann Surg. 1964; 160:373-83. PMC: 1408789. DOI: 10.1097/00000658-196409000-00005. View

15.

McGrath E, Blades Z, Anderson P . Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med. 2009; 104(1):1-8. DOI: 10.1016/j.rmed.2009.08.010. View

16.

Jain R, Padera T . Development. Lymphatics make the break. Science. 2003; 299(5604):209-10. DOI: 10.1126/science.1081345. View

17.

Gulati S, Gupta N, Singh N, Batra S, Garg S, Beniwal P . Chyluria with proteinuria or filarial nephropathy? An enigma. Parasitol Int. 2007; 56(3):251-4. DOI: 10.1016/j.parint.2007.03.002. View

18.

Skandalakis J, Skandalakis L, Skandalakis P . Anatomy of the lymphatics. Surg Oncol Clin N Am. 2007; 16(1):1-16. DOI: 10.1016/j.soc.2006.10.006. View

19.

Misthos P, Kanakis M, Lioulias A . Chylothorax complicating thoracic surgery: conservative or early surgical management?. Updates Surg. 2012; 64(1):5-11. DOI: 10.1007/s13304-012-0133-8. View

20.

Maged A . Renal chyluria. Br J Urol. 1967; 39(5):555-9. DOI: 10.1111/j.1464-410x.1967.tb11794.x. View