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Using aneurysm clips for repair of cisterna chyli injury during posterior spinal fusion

BACKGROUND: Injury to the cisterna chyli (CC) is a rare surgical complication with a lack of literature describing its repair. Aneurysm clips have been successfully used to repair durotomies. Its usage in lymphatic injury has never been described. We sought to demonstrate the use of aneurysm clips f...

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Autores principales: McCabe, Robert, Tong, Doris, Hanson, Connor, Slavnic, Dejan, Soo, Teck Mun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Scientific Scholar 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8422423/
https://www.ncbi.nlm.nih.gov/pubmed/34513191
http://dx.doi.org/10.25259/SNI_172_2021
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author McCabe, Robert
Tong, Doris
Hanson, Connor
Slavnic, Dejan
Soo, Teck Mun
author_facet McCabe, Robert
Tong, Doris
Hanson, Connor
Slavnic, Dejan
Soo, Teck Mun
author_sort McCabe, Robert
collection PubMed
description BACKGROUND: Injury to the cisterna chyli (CC) is a rare surgical complication with a lack of literature describing its repair. Aneurysm clips have been successfully used to repair durotomies. Its usage in lymphatic injury has never been described. We sought to demonstrate the use of aneurysm clips for the repair of lymphatic vessels. CASE DESCRIPTION: A 60-year-old male retired physician with Parkinson’s disease underwent a lumbosacral instrumented fusion with pelvic fixation (L1-pelvis) in 2011. He returned 5 months postoperatively after a fall and was ambulatory with a cane upon admission. CT demonstrated worsening kyphosis with pedicular and superior endplate fracture at the fusion apex. MRI revealed spinal cord compression at the failed level. Extension thoracolumbar fusion was performed (T3-L1) with intraoperative violation of the anterior longitudinal ligament (ALL) during T12/L1 discectomy. CC laceration was suspected. The ALL was dissected from the CC and aorta, allowing visualization of the injury. Three curved aneurysm clips were applied to the lacerated CC, which was visually inspected to ensure a patent lumen. The disk space was filled with poly-methyl-methacrylate cement in place of an interbody cage, preventing migration of the clips. The patient underwent rehabilitation in an inpatient facility with improved ambulation. He has had regular clinic follow-up and was last seen in 2020 with no evidence of lymphedema noted. CONCLUSION: CC injury is rare, and usage of aneurysm clips in its repair has never been described. We demonstrate the safe use of aneurysm clips to repair CC injury with long-term favorable clinical outcomes.
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spelling pubmed-84224232021-09-09 Using aneurysm clips for repair of cisterna chyli injury during posterior spinal fusion McCabe, Robert Tong, Doris Hanson, Connor Slavnic, Dejan Soo, Teck Mun Surg Neurol Int Case Report BACKGROUND: Injury to the cisterna chyli (CC) is a rare surgical complication with a lack of literature describing its repair. Aneurysm clips have been successfully used to repair durotomies. Its usage in lymphatic injury has never been described. We sought to demonstrate the use of aneurysm clips for the repair of lymphatic vessels. CASE DESCRIPTION: A 60-year-old male retired physician with Parkinson’s disease underwent a lumbosacral instrumented fusion with pelvic fixation (L1-pelvis) in 2011. He returned 5 months postoperatively after a fall and was ambulatory with a cane upon admission. CT demonstrated worsening kyphosis with pedicular and superior endplate fracture at the fusion apex. MRI revealed spinal cord compression at the failed level. Extension thoracolumbar fusion was performed (T3-L1) with intraoperative violation of the anterior longitudinal ligament (ALL) during T12/L1 discectomy. CC laceration was suspected. The ALL was dissected from the CC and aorta, allowing visualization of the injury. Three curved aneurysm clips were applied to the lacerated CC, which was visually inspected to ensure a patent lumen. The disk space was filled with poly-methyl-methacrylate cement in place of an interbody cage, preventing migration of the clips. The patient underwent rehabilitation in an inpatient facility with improved ambulation. He has had regular clinic follow-up and was last seen in 2020 with no evidence of lymphedema noted. CONCLUSION: CC injury is rare, and usage of aneurysm clips in its repair has never been described. We demonstrate the safe use of aneurysm clips to repair CC injury with long-term favorable clinical outcomes. Scientific Scholar 2021-08-30 /pmc/articles/PMC8422423/ /pubmed/34513191 http://dx.doi.org/10.25259/SNI_172_2021 Text en Copyright: © 2021 Surgical Neurology International https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Case Report
McCabe, Robert
Tong, Doris
Hanson, Connor
Slavnic, Dejan
Soo, Teck Mun
Using aneurysm clips for repair of cisterna chyli injury during posterior spinal fusion
title Using aneurysm clips for repair of cisterna chyli injury during posterior spinal fusion
title_full Using aneurysm clips for repair of cisterna chyli injury during posterior spinal fusion
title_fullStr Using aneurysm clips for repair of cisterna chyli injury during posterior spinal fusion
title_full_unstemmed Using aneurysm clips for repair of cisterna chyli injury during posterior spinal fusion
title_short Using aneurysm clips for repair of cisterna chyli injury during posterior spinal fusion
title_sort using aneurysm clips for repair of cisterna chyli injury during posterior spinal fusion
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8422423/
https://www.ncbi.nlm.nih.gov/pubmed/34513191
http://dx.doi.org/10.25259/SNI_172_2021
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