Chylothorax in spine fractures: a rarely reported complication? Literature review with an example case

Post-traumatic chylothorax may occur after blunt or penetrating trauma. We describe a case of chylothorax following a B3 fracture of the T12 vertebra, integrating our single-case experience into a focused literature review of this complication when it is directly associated with spine fractures.A PubMed search was performed by using the terms "chylothorax", "chyle leakage", "chylous leakage", "thoracic duct injury" combined with "spine", "fracture", "spine fracture", "spinal fracture", "vertebral fracture", "spine trauma", "spinal trauma", "spine injury" and "spinal injury". Nontraumatic chylothorax, iatrogenic chyle leakage, technical notes, purely descriptive papers, chylothorax as a consequence of chest and/or abdominal trauma, or studies on multiple thoracic and/or abdominal injuries were excluded. In addition to the 20 articles yielded by this search strategy, an example case of type B3 spine fracture, which caused a chylothorax, was discussed.The vast majority of chylothoraxes regarded spinal injuries from T9 to L1. A prevalence of type C fractures was noted. Pulmonary dysfunction usually developed 3-7 days after trauma, always requiring urgent thoracic drainage. Total parenteral nutrition and restrictive diet revealed insufficient with chyle leakage exceeding 1.5 litres/day, with prolonged drainage over 1 litre/day and with persisting chest tube outflow for more than 2 weeks or with deterioration in clinical status. Two dynamics of thoracic duct injury could be hypothesized: indirect lesion from an abrupt hyperextension of the spine overstressing the stretchability of the duct itself; and direct lesion likely depending from the thoracic duct overstretching and its concomitant impact against sharpened fracture margins or acuminated fracture fragments. Compared to vascular injuries sometimes complicating severely fragmented or dislocated spine fractures, chylothorax appears relatively underreported considering the greater anatomical fragility of the thoracic duct than an arterial vessel. LEVEL OF EVIDENCE: therapeutic.