Post thoracotomy spinal cord compression in a child. A word of caution
Meletios A Kanakis1, Andrew Chatzis, Elias Papadopoulos
1Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, Athens, Greece.
Insights
Oxidized regenerated cellulose, a surgical hemostatic agent, can rarely cause severe spinal cord compression. Surgeons must exercise caution when applying this material near the intervertebral foramen to prevent serious complications.
Area of Science:
- Neurosurgery
- Thoracic Surgery
- Surgical Materials
Background:
- Oxidized regenerated cellulose is a widely used hemostatic agent in surgical procedures.
- While effective, rare instances of severe complications have been reported.
Purpose of the Study:
- To report a rare case of spinal cord compression caused by oxidized regenerated cellulose.
- To highlight potential risks associated with hemostatic material placement near the intervertebral foramen.
Main Methods:
- Case presentation of a pediatric patient with paraplegia following tumor excision.
- Diagnostic imaging (MRI) to identify spinal cord compression.
- Surgical exploration to determine the causative agent.
Main Results:
- A 6-year-old girl developed flaccid paraplegia post-thoracic surgery.
- MRI revealed spinal cord compression at T10-11 level.
- Intraoperative findings identified a mass of oxidized regenerated cellulose compressing the spinal cord.
Conclusions:
- The intervertebral foramen provides a pathway for material migration into the spinal canal.
- Oxidized regenerated cellulose can cause severe complications like spinal cord compression.
- Caution is advised when placing hemostatic materials near the intervertebral foramen.
Introduction:
Oxidised regenerated cellulose is a commonly used haemostatic agent in surgery which, in rare cases, has been held responsible for severe complications.
Presentation Of Case:
A 6-year-old girl developed flaccid paraplegia following the excision of a large thoracic ganglioneuroblastoma. Magnetic resonance imaging revealed spinal cord compression at the T10-11 level and the patient underwent emergency decompression via the previous thoracotomy. At operation the causative factor was found to be a mass consisted of cellulose used at the original procedure to control local bleeding in the vicinity of the intervertebral foramen.
Discussion:
The accessibility of the spinal canal from the thoracic cavity through the opening of the intervertebral foramen may allow migration of material and in this case oxidized regenerated cellulose, commonly used during cardiothoracic procedures, can cause rare but severe complications such as compression of the spinal cord.
Conclusion:
The value of hemostatic gauze is well established in cardiothoracic surgery. However, surgeon should be cautious with the application of material in the proximity of the intervertebral foramen, especially if this is to leave behind after the completion of the procedure.
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