Postoperative Chyle-related Complications in Lumbar Spine Surgery: A Systematic Review of Risk Factors, Management Approaches, and Clinical Outcomes

Introduction: Postoperative chyle complications in lumbar spine surgery are rare and pose significant diagnostic and management challenges. Delayed diagnosis can lead to severe complications, including nutritional deficiencies, infection, and prolonged recovery. This systematic review aims to provide a comprehensive analysis of all reported cases of chyle complications in lumbar spine surgery, to better understand the demographics, clinical presentations, management options, and outcomes associated with this rare complication.

Methods: We conducted a systematic search using PubMed, Embase, and Scopus to identify articles on postoperative chyle complications in lumbar spine surgery. Case reports, series, and observational studies were included. We excluded studies involving thoracic duct injuries, abnormal lymphatic system conditions, and those with insufficient clinical data. Two reviewers independently screened the articles for inclusion. Data was extracted on demographics, surgical details, clinical presentation, management, and outcomes.

Results: We included 27 studies with a total of 62 patients. The mean age was 59.9 years, with 55.4% being female. Spinal deformity was the most common surgical indication (50.9%), followed by degenerative spine disease (24.6%). The majority of patients (89.3%) underwent an anterior lumbar spine approach. The most common chyle-related complication was isolated intra-abdominal lymphocele (91.2%). Abdominal swelling (51.8%) and pain (41%) were the most common presenting symptoms, with a median onset of 11 days postoperatively. Computed tomography was the most frequently used diagnostic tool (80.4%). Percutaneous drainage was the most common intervention (76.8%), with an 87.5% success rate. Most patients (93%) experienced complete resolution, with a few recurrences requiring further intervention.

Conclusion : Postoperative chyle complications following lumbar spine surgery are rare, but early diagnosis and intervention are crucial for achieving favorable outcomes. We hope that this systematic review summarizes the existing literature and provides an up-to-date understanding of the presentation, management, and outcome of this condition.