{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:48:42Z","timestamp":1791938922688,"version":"4.3.4"},"reference-count":17,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"15","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,10,12]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Postoperative lymphatic leakage is a rare complication of spine surgery caused by injury to the thoracic duct, cisterna chyli, or retroperitoneal lymphatic channels. Because of its rarity, diagnosis is often delayed and optimal management remains poorly defined. The authors present 3 illustrative cases and review current diagnostic and therapeutic strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>\n                      A 66-year-old man developed a right chylothorax after posterior T2\u20133 corpectomy with costotransversectomy and cervicothoracic fusion for metastatic spinal cord compression. Following failed thoracic duct embolization, he underwent thoracoscopic ligation and talc pleurodesis with complete resolution. A 75-year-old man developed a retroperitoneal lymphatic leak after an aborted oblique lumbar interbody fusion (OLIF), which resolved with percutaneous drainage and dietary modification. A 70-year-old woman developed a symptomatic retroperitoneal lymphatic leak after staged multilevel OLIF and posterior deformity correction. Intranodal lymphangiography localized the leak and enabled successful embolization with\n                      <jats:italic>n<\/jats:italic>\n                      -butyl cyanoacrylate, avoiding reoperation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Lymphatic injury after spine surgery is uncommon but may occur after both thoracic and retroperitoneal approaches. Early recognition, biochemical confirmation, and multidisciplinary management are essential. Lymphangiography is central to diagnosis and treatment, although refractory cases may require surgery. Awareness of these complications may improve patient outcomes.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26792\">https:\/\/thejns.org\/doi\/10.3171\/CASE26792<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26792","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:01:15Z","timestamp":1791331275000},"source":"Crossref","is-referenced-by-count":0,"title":["Thoracic and retroperitoneal lymphatic injuries following spine surgery: illustrative cases"],"prefix":"10.3171","volume":"12","author":[{"given":"Thiago P.","family":"Rodrigues","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Health Care, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana A. S.","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Iowa Health Care, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Health Care, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clayton L.","family":"Rosinski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Health Care, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5361-0414","authenticated-orcid":true,"given":"Mani Ratnesh S.","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Health Care, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Health Care, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5424-9483","authenticated-orcid":true,"given":"Mauricio","family":"Amoedo","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Iowa Health Care, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew A. Howard","family":"III","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Health Care, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Hitchon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Health Care, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"Global Spine J","first-page":"115S","article-title":"Thoracic duct injury following cervical spine surgery: a multicenter retrospective review","volume":"7","author":"Derakhshan","year":"2017","unstructured":"Derakhshan ALubelski DSteinmetz MPThoracic duct injury following cervical spine surgery: a multicenter retrospective review. Global Spine J. 2017;7(1)(suppl):115S-119S. doi:10.1177\/2192568216688194"},{"issue":"suppl 3","key":"bib2","series-title":"Eur Spine J","first-page":"332","article-title":"Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review","volume":"16","author":"Su","year":"2007","unstructured":"Su ICChen CM.Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review. Eur Spine J. 2007;16(suppl 3):332-337. doi:10.1007\/s00586-007-0305-2"},{"issue":"5","key":"bib3","series-title":"J Neurosurg Case Lessons","first-page":"CASE24280","article-title":"Delayed chylous fluid leakage at the surgical site following thoracic corpectomy via a lateral extracavitary approach: illustrative case","volume":"8","author":"Treffy","year":"2024","unstructured":"Treffy RWBakhaidar MShabani S.Delayed chylous fluid leakage at the surgical site following thoracic corpectomy via a lateral extracavitary approach: illustrative case. J Neurosurg Case Lessons. 2024;8(5):CASE24280. doi:10.3171\/CASE24280"},{"issue":"5","key":"bib4","series-title":"J Neurosurg Spine","first-page":"415","article-title":"Chyloretroperitoneum following anterior spinal surgery","volume":"17","author":"Hussain","year":"2012","unstructured":"Hussain NSHanscom DOskouian RJJr.Chyloretroperitoneum following anterior spinal surgery. 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Semin Intervent Radiol. 2011;28(1):63-74. doi:10.1055\/s-0031-1273941"},{"issue":"6","key":"bib7","series-title":"Head Neck","first-page":"1823","article-title":"Intranodal lymphangiography with thoracic duct embolization for the treatment of chyle leaks after head and neck cancer surgery","volume":"43","author":"Ushinsky","year":"2021","unstructured":"Ushinsky AGuevara CJKim SK.Intranodal lymphangiography with thoracic duct embolization for the treatment of chyle leaks after head and neck cancer surgery. Head Neck. 2021;43(6):1823-1829. doi:10.1002\/hed.26646"},{"issue":"4","key":"bib8","series-title":"Clin Anat","first-page":"637","article-title":"Review of thoracic duct anatomical variations and clinical implications","volume":"27","author":"Phang","year":"2014","unstructured":"Phang KBowman MPhillips AWindsor J.Review of thoracic duct anatomical variations and clinical implications. 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