Chylous leakage after thoracolumbar fracture may cause paraplegia.
METHODS
Retrospective case report.


OBJECTIVE
This case demonstrates that paraplegia can develop due to chylous leakage into the spinal canal without obvious retroperitoneal or intrathoracic involvement.


BACKGROUND
This clinical presentation of chylous leakage has not been reported previously. RESULTS A 61-year-old female with osteoporosis suffered a pathologic fracture of the vertebral bodies T12 and L1 and developed partial paraplegia two weeks later. Imaging showed expansive pooling of intraspinal fluid without intrathoracic or retroperitoneal involvement. A blood-tinged fluid was aspirated from dorsal. Repeated surgery by a posterior approach with drainage of the fluid did not improve the patient's condition, so she was finally transferred to our hospital. Under the suspected diagnosis of lymphatic leakage a scintiscan with 123I-iodinephenylpentadekanacid-marked cream verified the presumption of a lymph fistula at the level of T12/L1, originating from the thoracic duct. By permanent draining of the posterior fistula without suction and strict intravenous alimentation the fluid production decreased continuously and finally ceased completely. Simultaneously, the neurologic state improved gradually without returning to normal completely.


CONCLUSIONS
This case demonstrates that paraplegia can develop due to chylous leakage into the spinal canal without obvious retroperitoneal or intrathoracic involvement. This differential diagnosis should be kept in mind when treating patients with abundant fluid drainage into or from the spinal canal.
von Knoch
Marius
M
Departmentsof Orthopaedics, University of Essen, Essen, Germany. mariusvonknoch@yahoo.com
Michiels
Ivo
I
Mueller
Stefan
S
Siahkamary
Leila
L
D002913:Chyle; D019299:Decompression, Surgical; D003937:Diagnosis, Differential; D004322:Drainage; D005260:Female; D005402:Fistula / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D005598:Fractures, Spontaneous / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007457:Iodine Radioisotopes; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications; D010264:Paraplegia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011877:Radionuclide Imaging; D012086:Reoperation; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications / Q000175:diagnosis*; D013897:Thoracic Duct / Q000000981:diagnostic imaging / Q000473:pathology; D013904:Thoracic Vertebrae / Q000473:pathology*
D007457:Iodine Radioisotopes