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Chylous retroperitoneum following 720 degree anteroposterior-combined corrective surgery for adult spinal deformity with split vertebral fracture subluxation: a case report

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Abstract

Study design

Clinical case report.

Purpose

To report the rare case with post-operative chylous retroperitoneum after corrective surgery for adult spinal deformity.

Methods

We present a case of a 73-year-old woman with Parkinson’s disease. She sustained a severe split fracture subluxation of the L3 vertebra with AO Spine Thoracolumbar classification type CN2M2, resulting in severe kyphoscoliosis in global alignment. She underwent a two-stage 720-degree anteroposterior-combined corrective surgery with anterior vertebral column resection of L3 and posterior fusion from T4 to the pelvis. On post-operative day 1, milky fluid in the drainage tube was noted, which was diagnosed as post-operative chylous retroperitoneum.

Results

Oral intake was discontinued immediately and peripheral parenteral nutrition was started. A low-fat, high-protein diet was started on post-operative day 4, and drainage was removed on day 6. A low-fat diet was continued until 3 months post-operatively, with dietary counselling by a nutritionist. The chylous retroperitoneum resolved without recurrence at the final follow-up evaluation at 3 years.

Conclusion

Surgeons should recognize this rare complication, which might be induced by direct damage to the lymphatic flow during an operative maneuver anterior to the lumbar vertebral body and indirect damage due to shearing force during correction of a subluxated vertebra, especially in cases with a severe deformity.

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Acknowledgement

The present study was conducted under a protocol approved by the Institutional Review Board of Kitasato University School of Medicine.

Funding

No funding was received for this work.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Ken Takata, Toshiyuki Nakazawa, Masayuki Miyagi, Wataru Saito, Takayuki Imura, Eiki Shirasawa, Akiyoshi Kuroda, Ayumu Kawakubo, Yusuke Mimura, Yuji Yokozeki, Masashi Takaso & Gen Inoue

Authors
  1. Ken Takata
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  2. Toshiyuki Nakazawa
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  3. Masayuki Miyagi
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  12. Gen Inoue
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Contributions

Design of the work: KT, TN, MM, WS, TI, ES, GI. Acquisition of the data: AkK, AyK, YM, YY. Interpretation of the data: MT, GI. Drafting the work: All authors. Final approval of the version to be published: All authors. Agreement to be accountable for all aspects of the work: All authors.

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Correspondence to Gen Inoue.

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Takata, K., Nakazawa, T., Miyagi, M. et al. Chylous retroperitoneum following 720 degree anteroposterior-combined corrective surgery for adult spinal deformity with split vertebral fracture subluxation: a case report. Spine Deform 9, 1183–1189 (2021). https://doi.org/10.1007/s43390-021-00309-3

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