Thoracic Duct Injury in Spine Surgery: A Systematic Review of Presentation, Management, and Clinical Outcomes

Introduction: Thoracic duct injury (TDI) is a rare yet a serious complication in spine surgery that requires prompt identification and management. TDI can occur in the setting of spinal trauma or as an iatrogenic damage during spine surgery. Given the rarity of this complication and the paucity of literature on the subject, we conducted a systematic review to summarize all reported cases of TDI related to spine surgery. We aim to provide an up-to-date understanding of the presentation, diagnosis, management, and outcomes of this condition.

Methods: We conducted a systematic search to identify articles related to TDI in spine surgery. We included all observational reports that discussed spine surgery-related TDI. Two independent reviewers screened the articles for inclusion. Data were extracted on patient demographics, surgical details, clinical presentation, management strategies, and outcomes.

Results: We included 64 studies, involving a total of 70 patients with a mean age of 39 years. Two major groups were included for analysis, TDI secondary to spine trauma (28 patients, 40%) and TDI secondary to an iatrogenic injury (42 patients, 60%). In the traumatic group, injuries were mostly at the thoracolumbar level, with dislocation/translation fractures being the most common type (31%). In the iatrogenic group, the primary surgical indication was spinal deformity (54%) followed by degenerative spine disease (24%). Anterior cervical approaches were the cause of the TDI in 8 patients (19.05%). Patients presented with a median of 3 days after the initial etiological event. Chylothorax was the most frequent clinical diagnosis in both groups (70%). The most common therapeutic intervention was percutaneous drainage 80%, and most of the patients had complete resolution (96%). Two patients died due to complications.

Conclusion : This review offers an updated overview of this challenging complication and help to guide the diagnosis and management of this condition.