Postoperative cervical cord compression induced by hydrogel (DuraSeal): a possible complication

Area of Science:

• Neurosurgery
• Biomaterials Science
• Medical Device Safety

Background:

• Cerebrospinal fluid (CSF) leaks are known complications following spinal and posterior fossa surgery.
• Dural tears, often occurring during decompressive laminectomy or extradural spinal approaches, can lead to CSF leakage.
• Hydrogel-based sealants are utilized to repair dural tears, but their safety profile requires ongoing evaluation.

Observation:

• A patient undergoing C5-C6 anterior cervical discectomy and fusion experienced an intraoperative cerebrospinal fluid leak.
• The leak was managed using Surgicel and DuraSeal, a hydrogel sealant.
• Postoperatively, the patient developed quadriparesis attributed to the expansion of the hydrogel sealant.

Findings:

• Magnetic Resonance Imaging (MRI) revealed significant expansion of the hydrogel sealant.
• Re-exploration confirmed the hydrogel's expansion as the cause of the patient's neurological deficit.
• This case represents a second documented instance of hydrogel sealant causing potentially fatal expansion.

Implications:

• The findings underscore the critical need to consider the potential for hydrogel sealant expansion in the perioperative period.
• This case emphasizes the importance of careful patient selection and monitoring when using hydrogel sealants for dural repair.
• Further research into the long-term behavior and safety of hydrogel sealants in spinal surgery is warranted.