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Lumbar cauda equina syndrome associated with the use of gelfoam: case report
1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112-2699, USA.
Study Design:
A case of cauda equina syndrome is reported.
Objective:
To recognize a serious complication related to the use of Gelfoam in the lumbar spine.
Summary And Background Data:
Absorbable hemostatic gelatin sponges have long been used to control bleeding around the spinal cord. Despite widespread use and a safe history with few reported adverse reactions, Gelfoam sponges have potential for complications that may be overlooked.
Method:
A case of cauda equina syndrome is reported and discussed.
Results:
A retained Gelfoam sponge was found in the epidural space after lumbar decompression and fusion for spinal stenosis. The retained gelatin sponge had expanded and solidified, causing a mass affect. The resultant nerve compression led to progressive myelopathy. On removal of the Gelfoam, symptoms rapidly resolved.
Conclusions:
Although the use of Gelfoam in spine surgery generally is considered safe, care must be taken to avoid placing a large mass of sponge in a potentially closed space. If Gelfoam is not handled properly, it can engorge and fail to be resorbed appropriately, thus causing a mass effect. If neurologic compromise develops, Gelfoam should be considered a potential cause and subsequently removed.